{ "slug": "drainage-pilonidal", "question": "How long does it take to recover after a pilonidal cyst is drained?", "shortTitle": "Recovery After Pilonidal Abscess Drainage", "clinicalQuestion": "In patients with a pilonidal abscess treated by incision and drainage, what is the typical time to wound healing, return to normal activity, and recurrence, and how do these outcomes differ from other surgical approaches?", "pico": { "population": "Patients with an acute pilonidal abscess or cyst undergoing incision and drainage", "intervention": "Incision and drainage (simple lancing/drainage of the abscess, with or without packing)", "comparator": "Definitive excisional surgery or no drainage/watchful waiting", "outcomes": [ "Time to complete wound healing", "Time to return to work or normal activity", "Post-procedure pain scores", "Wound discharge duration", "Need for further (definitive) surgery", "Recurrence rate at 6–12 months" ] }, "category": "anorectal", "relatedConditions": [ "pilonidal-cyst", "pilonidal-abscess", "pilonidal-sinus" ], "relatedTreatments": [], "relatedEvidence": [], "bottomLine": { "verdict": "Draining a pilonidal abscess relieves the acute infection quickly, but it doesn't reliably end the problem — in the studies that followed patients afterward, a sizeable share had the abscess come back or needed a second operation.", "detail": "The one randomised trial that directly tested this compared drainage alone with drainage plus curettage (scraping out the cavity) and found more recurrences with drainage alone (42% vs 11%). Several other studies of people treated with incision and drainage alone found 21–29% had the disease return, and many of these needed further surgery. Because only one trial addresses this question directly and other studies disagree on how fast the wound heals, this evidence is low-certainty.", "studyIds": [ "pmid:15900358", "pmid:12520844", "pmid:3337954", "pmid:25664095" ] }, "strength": { "level": "low", "why": "One well-conducted randomised trial addresses this question directly. The studies disagree with one another, so the overall certainty is lower than any single one of them.", "override": null }, "direction": { "level": "harm-signal", "why": "2 studies reported harm or tissue damage, including laboratory evidence.", "override": null }, "counts": { "recordsRetrieved": 131, "recordsScreened": 131, "included": 98, "rcts": 18, "systematicReviews": 5, "observational": 31, "participants": 9912, "yearFrom": 1956, "yearTo": 2026, "registeredTrialsWithoutResults": 4 }, "excluded": [], "outcomes": [ { "name": "Time to complete wound healing", "status": "insufficient", "note": "Studies that tracked healing after incision and drainage reported very different timelines — a median of 43 days in one large cohort, about 18 days in another, and only 58–79% of patients fully healed within 10 weeks in two others. The studies used different definitions of 'healed' and followed different populations, so no single recovery time can be given.", "studyIds": [ "pmid:39635960", "pmid:25664095", "pmid:15900358", "pmid:3337954" ] }, { "name": "Time to return to work or normal activity", "status": "insufficient", "note": "A few small studies reported people back to usual activity within about two weeks after a similar procedure (cystotomy), while another found incision and drainage let people return to work sooner than excision surgery done at the same time (about 26 days vs 35 days). These numbers come from different procedures and countries, so they don't add up to one clear answer.", "studyIds": [ "pmid:862487", "pmid:12836108", "pmid:36542008" ] }, { "name": "Post-procedure pain scores", "status": "not-studied", "note": "No study in this review measured pain scores specifically after simple incision and drainage of an abscess. Pain was measured for other things, like wound dressings after bigger excision surgery, but not for drainage itself.", "studyIds": [] }, { "name": "Wound discharge duration", "status": "not-studied", "note": "No study directly measured how long a wound keeps discharging fluid after simple incision and drainage of an abscess.", "studyIds": [] }, { "name": "Need for further (definitive) surgery", "status": "possible-harm", "note": "Several studies suggest that a meaningful share of people treated with drainage alone later need further surgery. In one study of incision and drainage alone, later excision was necessary in under 40% of patients. In another, 29% of patients treated by incision and drainage alone had a recurrence that required a new operation.", "studyIds": [ "pmid:6733433", "pmid:12520844" ] }, { "name": "Recurrence rate at 6–12 months", "status": "possible-harm", "note": "The one randomised trial on this found the abscess or sinus came back in 42% of people treated with drainage alone, versus 11% when curettage (scraping the cavity) was added. Other studies of drainage alone found recurrence in 21–29% of patients.", "studyIds": [ "pmid:15900358", "pmid:12520844", "pmid:3337954" ] } ], "benefits": [ { "text": "Simple incision and drainage treats the acute infection quickly and can be done under local anaesthetic, without needing a bigger operation at that visit.", "studyIds": [ "pmid:3337954", "pmid:39635960" ] }, { "text": "In studies that compared it with more extensive excision surgery done at the same visit, simple drainage let people return to work or normal activity sooner.", "studyIds": [ "pmid:36542008", "pmid:12836108" ] } ], "limitations": [ { "text": "Only one randomised trial compares drainage alone against another approach using proper randomisation; most of the rest of the evidence comes from case series or retrospective reviews with no comparison group at all.", "studyIds": [ "pmid:15900358" ] }, { "text": "Studies span 1956 to 2026 and use different surgical techniques, different definitions of 'healed,' and different follow-up lengths, so their healing-time numbers cannot be directly combined.", "studyIds": [ "pmid:39635960", "pmid:25664095", "pmid:21533783", "pmid:3337954", "pmid:862487" ] }, { "text": "Many studies lump incision and drainage together with other techniques (excision, flap surgery, marsupialization) in the same group of patients, making it hard to isolate what happens after simple drainage alone.", "studyIds": [ "pmid:17305995", "pmid:10765903" ] }, { "text": "Follow-up was often incomplete — some studies only checked patients at an outpatient visit and lost a meaningful share to follow-up, so later recurrences may be undercounted.", "studyIds": [ "pmid:39635960", "pmid:3337954" ] } ], "risks": [ { "text": "Across studies of people treated with incision and drainage alone, the abscess or sinus came back in roughly a fifth to over two-fifths of patients, and most of these needed another operation to fix it.", "studyIds": [ "pmid:15900358", "pmid:12520844", "pmid:3337954" ], "severity": "serious" }, { "text": "One study compared two approaches to managing a pilonidal abscess: early surgery (unroofing and curettage) done right away versus elective surgery (a Karydakis flap) done later, after initial drainage and antibiotics. The total time treatment took differed significantly between the two groups, but the abstract does not say which group took longer.", "studyIds": [ "pmid:25541849" ], "severity": "minor" } ], "whyPeopleTryIt": [ { "text": "It's usually the fastest way to relieve severe pain and pressure from an acute abscess." }, { "text": "It can be done quickly in an emergency room or clinic under local anaesthetic, without a hospital stay." }, { "text": "Many people hope draining the abscess will be the end of the problem and avoid a bigger operation." }, { "text": "It's the traditional, most familiar first step doctors offer for a painful pilonidal abscess." } ], "keyStudies": [ "pmid:15900358", "pmid:39635960", "pmid:12520844", "pmid:3337954", "pmid:25664095", "pmid:21533783", "pmid:25541849", "pmid:36542008" ], "studies": [ { "id": "pmid:42112873", "pmid": "42112873", "doi": "10.1111/ans.70737", "nctId": null, "pmcid": null, "title": "Endoscopic Pilonidal Sinus Treatment Versus Excisional Surgery: A Retrospective Comparison at an Australian Tertiary Centre", "firstAuthor": "Hlaing", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2026, "design": "retrospective", "n": 180, "nField": "reported", "population": "patients aged 12 and older having planned pilonidal cyst surgery at an Australian hospital", "intervention": "endoscopic pilonidal sinus treatment (EPSiT)", "comparator": "traditional excisional surgery (flap closure, lay-open excision, or primary closure)", "primaryOutcome": "wound healing and recurrence after healing", "result": "Healing rates were similar between the two surgery types, and recurrence was similar overall, but in patients who had a prior abscess drainage, recurrence after healing was higher with the endoscopic treatment", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a retrospective, non-randomized comparison at a single hospital, so differences between groups could be due to other factors rather than the treatment itself.", "directness": "indirect", "limitations": "Retrospective design, single tertiary centre, not randomized, and the question of recovery time after simple drainage is not the focus — this study compares two different surgical techniques for pilonidal disease.", "followUp": "", "plainFinding": "Similar healing, but faster discharge with endoscopic surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/42112873/", "sourceText": "BACKGROUND: Endoscopic pilonidal sinus treatment (EPSiT) may reduce recovery burden, but comparative data against contemporary excisional practices in Australia are limited. METHODS: We conducted a retrospective cohort study of consecutive elective pilonidal operations in patients aged ≥ 12 at a tertiary Australian hospital (January 2018-May 2025). Analyses were performed at the operative episode level, including repeat procedures. EPSiT was compared with excisional surgery (off-midline flap closure, lay-open excision or primary closure). The primary outcomes were primary healing and recurrence after healing. Secondary outcomes were same-day discharge and opioid prescription at discharge. RESULTS: The cohort included 180 elective operative episodes in 144 patients: 115 EPSiT (63.9%) and 65 excisional (36.1%). Primary healing occurred in 158 episodes (87.8%) and did not differ between EPSiT and excision (89.6% vs. 84.6%; p = 0.330). Recurrence occurred in 26.6% and was similar between groups (29.1% vs. 21.8%; p = 0.322). EPSiT was associated with higher same-day discharge (86.1% vs. 21.5%; p < 0.001) and lower opioid prescribing at discharge (2.6% vs. 63.1%; p < 0.001). In the subgroup with prior emergency I&D (n = 66), primary healing remained similar (89.5% vs. 85.7%; p = 0.644), but recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041). CONCLUSIONS: EPSiT achieved similar primary healing and recurrence to excisional surgery while enabling ambulatory care and opioid-sparing discharge. Prior abscess I&D was associated with higher recurrence after EPSiT despite comparable primary healing, supporting tailored counselling and selective EPSiT use when long-term durability is prioritised.", "provenance": [ { "field": "n", "quote": "The cohort included 180 elective operative episodes in 144 patients" }, { "field": "population", "quote": "consecutive elective pilonidal operations in patients aged ≥ 12" }, { "field": "intervention", "quote": "Endoscopic pilonidal sinus treatment (EPSiT)" }, { "field": "comparator", "quote": "excisional surgery (off-midline flap closure, lay-open excision or primary closure)" }, { "field": "primaryOutcome", "quote": "The primary outcomes were primary healing and recurrence after healing." }, { "field": "result", "quote": "Primary healing occurred in 158 episodes (87.8%) and did not differ between EPSiT and excision (89.6% vs. 84.6%; p = 0.330). Recurrence occurred in 26.6% and was similar between groups (29.1% vs. 21.8%; p = 0.322)." }, { "field": "result", "quote": "recurrence after healing was higher following EPSiT (47.1% vs. 20.8%; p = 0.041)" } ] }, { "id": "pmid:41880146", "pmid": "41880146", "doi": "10.1007/s13304-026-02536-7", "nctId": null, "pmcid": null, "title": "Negative pressure wound therapy in primary closure surgeries for pilonidal disease: a meta-analysis", "firstAuthor": "Martins", "multipleAuthors": true, "journal": "Updates Surg", "year": 2026, "design": "meta-analysis", "n": 479, "nField": "reported", "population": "patients with pilonidal cysts having surgical closure", "intervention": "negative pressure wound therapy (NPWT) after primary closure surgery", "comparator": "primary closure surgery without NPWT", "primaryOutcome": "pain, return to activities, wound closure time, and other recovery measures", "result": "NPWT linked to less pain at 24 hours and faster return to activities, but no difference in wound closure time, dehiscence, infection, recurrence, or hospital stay", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Based on only six studies with limited patients, and the authors say more randomized trials are needed.", "directness": "indirect", "limitations": "Small number of included studies; authors call for more randomized clinical trials; wide confidence intervals on several outcomes.", "followUp": "", "plainFinding": "Faster return to activity, less pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/41880146/", "sourceText": "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.", "provenance": [ { "field": "n", "quote": "Six studies with a total of 479 patients were included" }, { "field": "population", "quote": "patients with sacrococcygeal pilonidal sinus" }, { "field": "intervention", "quote": "Primary closure with negative pressure wound therapy (NPWT)" }, { "field": "comparator", "quote": "non-NPWT (control)" }, { "field": "primaryOutcome", "quote": "lower pain score 24 h postoperative" }, { "field": "result", "quote": "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" } ] }, { "id": "pmid:41461191", "pmid": "41461191", "doi": "10.1055/a-2773-3657", "nctId": null, "pmcid": null, "title": "In-Office Pit Excision for Pilonidal Disease Using Needle-Free Local Anesthesia: A Minimally Invasive, Non-Operative Treatment Approach", "firstAuthor": "Stoeckel", "multipleAuthors": true, "journal": "Eur J Pediatr Surg", "year": 2026, "design": "case-series", "n": 100, "nField": "reported", "population": "young patients (average age 18) with pilonidal disease (gluteal crease pits)", "intervention": "in-office pit excision with needle-free local anesthesia (laser follicle ablation plus small punch excision), excluding tract removal", "comparator": "none; single-arm study, no comparison group", "primaryOutcome": "whether all pits healed at follow-up", "result": "60% of patients had all pits healed at initial follow-up, rising to 88% healed overall; no pain medication or disability was reported", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-arm study with no comparison group and 25 of 130 patients lost to follow-up, so it can't say how this compares to other treatments or confirm long-term results.", "directness": "indirect", "limitations": "No comparator group, 25/130 (19%) lost to follow-up, and the study explicitly excluded patients who needed incision and drainage of an abscess, so it doesn't address recovery after that procedure.", "followUp": "6 to 8 weeks", "plainFinding": "Fast healing after pit excision, not drainage", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41461191/", "sourceText": "INTRODUCTION: Treatment of pilonidal disease traditionally involves an operation under general anesthesia, which may have a period of postoperative disability and a significant recurrence rate. We report a novel treatment for pilonidal disease performed in-office using a pneumatic lidocaine injection device, requiring no pain medication or activity restrictions-supporting a non-operative standard of care. METHODS: Patients with gluteal crease pits at our Pilonidal Care Clinic were offered pit excision as standard care. Prospective data on demographics, pain scores (0-10), and outcomes were collected in REDCap. Under sterile conditions, patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium. Sinus tracts were probed but not excised. Patients were asked to wash the area twice daily, maintain normal activities, and return in 6 to 8 weeks. Patients requiring nidus incision and drainage (I&D) were excluded. RESULTS: About 130 patients underwent this technique between February and June 2024; 100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up). Mean age was 18.1 years; 50% were male. At subsequent follow-up, 60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed. Patients with three or more pits were more likely to need an additional pit excision. Mean procedure pain score was 1.6/10 (SD 1.21); no patient used pain medication or experienced disability. Ultimately, 88% of patients healed all of their pits. CONCLUSION: Pilonidal disease may be resolved non-operatively in a single outpatient clinic visit, without even a shot.", "provenance": [ { "field": "population", "quote": "Mean age was 18.1 years; 50% were male." }, { "field": "intervention", "quote": "patients received 1% buffered lidocaine via pneumatic injection. Laser follicle ablation was followed by punch excision (1.5 or 2 mm) of full-thickness pit epithelium." }, { "field": "comparator", "quote": "Patients requiring nidus incision and drainage (I&D) were excluded." }, { "field": "primaryOutcome", "quote": "60% patients healed all pits, resolving their condition, with 64% (144/224) of all pits healed" }, { "field": "result", "quote": "Ultimately, 88% of patients healed all of their pits." }, { "field": "n", "quote": "100 were included in the analysis (5 excluded for concurrent I&D, 25 lost to follow-up)." } ] }, { "id": "pmid:41454773", "pmid": "41454773", "doi": "10.1093/jpids/piaf115", "nctId": null, "pmcid": null, "title": "Patient characteristics and microbiology in pilonidal abscesses in children", "firstAuthor": "Garcia", "multipleAuthors": true, "journal": "J Pediatric Infect Dis Soc", "year": 2026, "design": "retrospective", "n": 154, "nField": "reported", "population": "children with pilonidal abscesses", "intervention": "not applicable - observational study of abscess episodes", "comparator": "not applicable", "primaryOutcome": "microbiology of abscesses and patient characteristics associated with recurrence", "result": "anaerobes and Streptococcus anginosus were most common bacteria found; no factors linked to recurrence were found", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective chart review describing bacteria and recurrence risk, not recovery time after drainage, so it offers no evidence on the question asked.", "directness": "indirect", "limitations": "Retrospective design; does not report recovery time after drainage; abstract does not describe study limitations.", "followUp": "", "plainFinding": "No data on recovery time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/41454773/", "sourceText": "We described the microbiology of 216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center and assessed patient characteristics associated with recurrence. Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures. No risk factors for recurrence were identified.", "provenance": [ { "field": "n", "quote": "216 pilonidal abscess episodes among 154 children" }, { "field": "population", "quote": "216 pilonidal abscess episodes among 154 children over a 10-year period at a tertiary pediatric center" }, { "field": "primaryOutcome", "quote": "assessed patient characteristics associated with recurrence" }, { "field": "result", "quote": "Anaerobes and Streptococcus anginosus group were the most common organisms isolated from surgical cultures. No risk factors for recurrence were identified." }, { "field": "intervention", "quote": "microbiology of 216 pilonidal abscess episodes" }, { "field": "comparator", "quote": "No risk factors for recurrence were identified." } ] }, { "id": "pmid:40821131", "pmid": "40821131", "doi": "10.7759/cureus.88193", "nctId": null, "pmcid": "PMC12357775", "title": "A Case Report of Wound-Vacuum-Assisted Closure (VAC) Treatment Following Pilonidal Cyst Excision", "firstAuthor": "Ukleja", "multipleAuthors": true, "journal": "Cureus", "year": 2025, "design": "case-series", "n": 1, "nField": "reported", "population": "28-year-old man with a recurring pilonidal cyst and chronic sinus tract", "intervention": "surgical removal of the cyst followed by vacuum-assisted wound closure (wound-VAC)", "comparator": "none (single case, no comparison group)", "primaryOutcome": "time and process of wound healing after surgery", "result": "wound healed through secondary intention over about three to four weeks total, with granulation tissue forming by day eight and minimal pain, no complications", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a single patient case report, so it cannot show whether this approach works better than others or is typical.", "directness": "indirect", "limitations": "only one patient, no comparison group, so results may not apply broadly", "followUp": "three weeks", "plainFinding": "Healed fully within about a month.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40821131/", "sourceText": "Pilonidal cysts are subcutaneous cysts that typically occur in the sacrococcygeal region and are more prevalent in obese, hirsute males. Pilonidal cysts are believed to be caused by a pore that forms as hairs become drawn deeper within the pore, ultimately creating a sinus. Different therapeutic options have been described, including excision with primary closure, healing by secondary intention, or flap creation; however, finding the optimal approach is a work in progress. We report a case of an otherwise healthy 28-year-old man who presented with a recurrent pilonidal cyst with a chronic sinus tract despite previous repeat incision and drainage procedures. The patient underwent pilonidal cyst excision with vacuum-assisted wound closure (wound-VAC) placement to facilitate the healing process. After two changes of the wound-VAC dressing (postoperative day eight), fresh granulations formed. The wound size and the wound depth decreased, requiring no further need for wound-VAC dressing. Over the next three weeks, the wound healed via secondary intention with a simple dry-to-dry gauze dressing with minimal intermittent pain and without any complications.", "provenance": [ { "field": "n", "quote": "an otherwise healthy 28-year-old man" }, { "field": "population", "quote": "an otherwise healthy 28-year-old man who presented with a recurrent pilonidal cyst with a chronic sinus tract despite previous repeat incision and drainage procedures" }, { "field": "intervention", "quote": "underwent pilonidal cyst excision with vacuum-assisted wound closure (wound-VAC) placement to facilitate the healing process" }, { "field": "comparator", "quote": "We report a case of an otherwise healthy 28-year-old man" }, { "field": "primaryOutcome", "quote": "The wound size and the wound depth decreased, requiring no further need for wound-VAC dressing." }, { "field": "result", "quote": "Over the next three weeks, the wound healed via secondary intention with a simple dry-to-dry gauze dressing with minimal intermittent pain and without any complications." } ] }, { "id": "pmid:40288765", "pmid": "40288765", "doi": "10.1111/iwj.70194", "nctId": null, "pmcid": "PMC12034373", "title": "What is the Impact of Negative Pressure Wound Therapy on Healing in Patients Post Excision of Pilonidal Sinus? A Systematic Review and Meta-Analysis", "firstAuthor": "Morais", "multipleAuthors": true, "journal": "Int Wound J", "year": 2025, "design": "meta-analysis", "n": null, "nField": "not-reported", "population": "people who had surgery to remove a pilonidal sinus (cyst)", "intervention": "negative pressure wound therapy (a vacuum dressing) on the wound", "comparator": "other types of wound dressings", "primaryOutcome": "time to healing, wound recurrence, pain and patient satisfaction", "result": "it is unclear whether NPWT makes any difference compared to other dressings on healing time, recurrence, pain or patient experience", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "the review graded the evidence as very low certainty, meaning the results could easily change with better studies", "directness": "indirect", "limitations": "studies were small (average 61 patients), mixed study designs, and certainty of evidence was rated very low", "followUp": "", "plainFinding": "No clear benefit, evidence very weak", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/40288765/", "sourceText": "This systematic review aimed to determine the impact of negative pressure wound therapy on healing in patients with pilonidal sinus following surgical excision. Using systematic review methodology, we included original research studies written in English. The search was conducted using CINAHL Plus, Ovid, PubMed, EBSCO Host and Cochrane databases. Quality appraisal was undertaken using the Cochrane Collaboration tool for assessing risk of bias and the Grading of Recommendations Assessment, Development and Evaluation (GRADE). Data were analysed using meta-analysis where appropriate; otherwise, the data are presented narratively. Ten studies were included with a mean sample size of 61 (SD: 33). Three studies were randomised control trials, four were retrospective studies, two were prospective cohort studies and one was pre-post study. Studies showed reduction in healing time, recurrence rates and postoperative pain, as well as higher patients' satisfaction with the use negative pressure wound therapy, however, the certainty of the evidence was very low. The evidence for the intervention is uncertain thus, it is unclear whether NPWT makes any difference when compared to any other dressings, on time to healing, recurrence, pain or patient's experience. Further high-quality research with larger sample sizes is recommended to clearly explore the impact of NPWT on PS healing, recurrence, pain and patient's satisfaction.", "provenance": [ { "field": "population", "quote": "patients with pilonidal sinus following surgical excision" }, { "field": "intervention", "quote": "negative pressure wound therapy" }, { "field": "comparator", "quote": "any other dressings" }, { "field": "primaryOutcome", "quote": "time to healing, recurrence, pain or patient's experience" }, { "field": "result", "quote": "it is unclear whether NPWT makes any difference when compared to any other dressings, on time to healing, recurrence, pain or patient's experience" }, { "field": "n", "quote": "mean sample size of 61 (SD: 33)" } ] }, { "id": "pmid:40056380", "pmid": "40056380", "doi": "10.12968/jowc.2021.0250", "nctId": null, "pmcid": null, "title": "Vacuum-assisted closure in secondary wound healing after pilonidal sinus surgery", "firstAuthor": "Hüseyin", "multipleAuthors": true, "journal": "J Wound Care", "year": 2025, "design": "retrospective", "n": 60, "nField": "reported", "population": "patients who had surgery for pilonidal sinus disease (excision lay-open technique)", "intervention": "vacuum-assisted closure wound care after surgery", "comparator": "standard open wound care", "primaryOutcome": "time until the wound completely healed", "result": "wound healing took about 21 days with vacuum-assisted closure versus about 68 days with standard care", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small retrospective study of only 60 patients, not a randomized trial, so it carries less weight.", "directness": "indirect", "limitations": "Retrospective analysis; small sample size; authors call for larger prospective studies to confirm findings.", "followUp": "", "plainFinding": "Faster healing with vacuum dressing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/40056380/", "sourceText": "OBJECTIVE: This study evaluated the utility of vacuum-assisted closure (VAC) in comparison to standard open wound care in patients operated for pilonidal sinus disease (PSD). METHOD: Patients with PSD who underwent standard pilonidal sinus excision-lay open technique/surgery in the Altınbas University School of Medicine Bahcelievler Medical Park Hospital, Istanbul, Turkey, between May 2015 and May 2018, were included in this study. A retrospective analysis of prospectively collected data was performed. The patients were divided into two groups according to the type of wound care, including the vacuum-assisted closure group (n=30, postoperative vacuum-assisted closure application) and the control group (n=30, standard open wound care). Wound size, postoperative infection rates and wound healing times were compared between study groups. RESULTS: The experimental cohort included 60 patients. There was no statistically significant difference between vacuum-assisted closure and the control groups in terms of preoperative and postoperative infection rates (p>0.05). The total recovery time (time to complete wound healing) was significantly shorter in the vacuum-assisted closure group compared with the control group (21.47±4.38 days versus 67.60±7.83 days, p=0.001). CONCLUSION: The findings of this study emphasise that the use of vacuum-assisted closure in PSD patients treated with the lay-open technique seems notable in terms of its potential to shorten the otherwise longer secondary recovery time and thus enables the consideration of the lay-open technique once again among the most preferable methods. However, there is a need for larger scale prospective studies addressing the utility of vacuum-assisted closure in patients with PSD to validate these findings.", "provenance": [ { "field": "n", "quote": "The experimental cohort included 60 patients." }, { "field": "population", "quote": "Patients with PSD who underwent standard pilonidal sinus excision-lay open technique/surgery" }, { "field": "intervention", "quote": "vacuum-assisted closure group (n=30, postoperative vacuum-assisted closure application)" }, { "field": "comparator", "quote": "control group (n=30, standard open wound care)" }, { "field": "primaryOutcome", "quote": "wound healing times were compared between study groups" }, { "field": "result", "quote": "The total recovery time (time to complete wound healing) was significantly shorter in the vacuum-assisted closure group compared with the control group (21.47±4.38 days versus 67.60±7.83 days, p=0.001)." } ] }, { "id": "pmid:39875233", "pmid": "39875233", "doi": "10.1016/j.jviscsurg.2024.12.005", "nctId": null, "pmcid": null, "title": "Management of pilonidal sinus and recurrences in 2025", "firstAuthor": "Darnis", "multipleAuthors": true, "journal": "J Visc Surg", "year": 2025, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus (a cyst/abscess at the top of the buttocks)", "intervention": "surgical removal (excision) with the wound left open to heal, or minimally invasive techniques", "comparator": "primary closure after excision, or other surgical strategies", "primaryOutcome": "healing time, recurrence, and complications", "result": "the abstract discusses treatment options and their trade-offs in recurrence and healing time but does not report a specific recovery time after drainage of an abscess", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this is a general narrative review summarizing treatment strategies rather than a study measuring recovery time after drainage", "directness": "indirect", "limitations": "abstract is a narrative review, not a study, and does not address recovery time after simple abscess drainage specifically", "followUp": "", "plainFinding": "No recovery time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39875233/", "sourceText": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration. This lesion corresponds histologically to a granuloma that organizes around foreign bodies, most often hairs, and fistulizes to the skin through partially epithelialized orifices. If suppuration and abscess develop, treatment is based either on medical treatment combining analgesics, local antiseptics and sometimes antibiotics, or on emergency incision and drainage in the operating room. This is performed in more than 10,000 patients per year in France. Outside of emergencies, elective surgery for pilonidal sinus is indicated to treat bothersome symptoms or to avoid the risk of recurrent abscess. The surgical indication must take into account the patient's risk factors, particularly active smoking, that increase the risk of postoperative complications and recurrence. Elective intervention is performed on more than 30,000 patients per year in France. Radical excision followed by secondary healing is the most commonly performed option. This strategy carries a risk of failure or recurrence for at least 10% of patients. Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications. Midline closure should be avoided, in favor of paramedian or flap closure. Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls. They avoid complex and unpleasant nursing care of secondarily healing wounds, at the cost of a recurrence rate equivalent to that from excision techniques. They have the merit of avoiding difficult situations of failure to heal or recurrence after radical excision that are associated with a clear deterioration in the quality of life. The treatment of surgical failures is complex, and combines comprehensive patient care (smoking cessation, anti-infectious treatments, treatment of excess weight, avoidance of a sedentary lifestyle) and often a repeat operation. Minimally invasive treatments, particularly laser treatments, have their place in these difficult situations.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus is a common pathology of the intergluteal cleft that can develop into abscess or suppuration." }, { "field": "intervention", "quote": "Radical excision followed by secondary healing is the most commonly performed option." }, { "field": "comparator", "quote": "Primary closure after excision can reduce the time for healing and convalescence, but at the cost of more frequent infectious complications." }, { "field": "primaryOutcome", "quote": "This strategy carries a risk of failure or recurrence for at least 10% of patients." }, { "field": "result", "quote": "Minimally invasive techniques are being developed that combine the extraction of foreign bodies and mechanical debridement or thermal or chemical cautery of the granulomatous walls." } ] }, { "id": "pmid:39635960", "pmid": "39635960", "doi": "10.1111/codi.17254", "nctId": null, "pmcid": "PMC11683315", "title": "Acute pilonidal abscess: Prospective nationwide audit in the Netherlands", "firstAuthor": "Huurman", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2024, "design": "prospective-cohort", "n": 205, "nField": "reported", "population": "patients with acute pilonidal abscess", "intervention": "incision and drainage of pilonidal abscess", "comparator": "none (single-arm outcomes study)", "primaryOutcome": "wound healing and time to wound closure", "result": "wound healing occurred in 42.2% at outpatient follow-up, with median time to closure of 43 days", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "it is a large multicenter prospective study but has no comparison group, so it only describes outcomes rather than proving what works best.", "directness": "direct", "limitations": "no comparator group; only 77.1% completed 1-year questionnaires; wound healing assessed only up to outpatient follow-up", "followUp": "1 year", "plainFinding": "Healing often slow, about 6 weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39635960/", "sourceText": "AIM: The aim of this study was to assess Dutch surgical practice and outcomes for acute pilonidal abscess. METHOD: Patients with pilonidal sinus disease (PSD) who underwent surgical treatment between 1 March 2020 and 1 March 2021 at 36 participating hospitals were included in a prospective observational cohort study. For the present study, only patients with an acute abscess were included for analysis. Outcomes included symptoms, wound healing, time to resume daily activities and complications. Follow-up was 1 year and included questionnaires on recurrent abscesses, symptomatic chronic PSD, quality of life and patient-reported experience measures. RESULTS: Of 681 included patients, 208 presented with an acute pilonidal abscess. Incision and drainage (I&D) was performed in 205 of these patients (99%). The wound healing rate after I&D was 42.2% at the outpatient clinic, with a median time to closure of 43 days. The complication rate was 4.4%. One-year questionnaires were completed by 158 out of 205 patients (77.1%). Fifteen patients (7.3%) had a recurrent abscess within 1 year. The symptomatic chronic PSD rate was 8.8%. CONCLUSION: Of all the patients presenting with PSD in this prospective national study cohort, 30% had a pilonidal abscess. Incision and drainage showed a low complication rate but successful wound healing in less than half of the patients. The study showed that 91.2% of patients did not undergo additional surgical treatment for symptomatic chronic PSD within 1 year of follow-up.", "provenance": [ { "field": "population", "quote": "Patients with pilonidal sinus disease (PSD) who underwent surgical treatment" }, { "field": "n", "quote": "Incision and drainage (I&D) was performed in 205 of these patients (99%)." }, { "field": "intervention", "quote": "Incision and drainage (I&D) was performed in 205 of these patients" }, { "field": "comparator", "quote": "Incision and drainage (I&D) was performed in 205 of these patients (99%)." }, { "field": "primaryOutcome", "quote": "Outcomes included symptoms, wound healing, time to resume daily activities and complications." }, { "field": "result", "quote": "The wound healing rate after I&D was 42.2% at the outpatient clinic, with a median time to closure of 43 days." } ] }, { "id": "pmid:39393119", "pmid": "39393119", "doi": "10.1016/j.jss.2024.09.016", "nctId": null, "pmcid": null, "title": "Negative Pressure Dressing Versus Conventional Passive Dressing in Pilonidal Surgery: A Randomized Controlled Trial", "firstAuthor": "Ensor", "multipleAuthors": true, "journal": "J Surg Res", "year": 2024, "design": "rct", "n": 50, "nField": "reported", "population": "patients aged 12 to 40 with pilonidal sinus disease needing surgical removal and stitched closure", "intervention": "negative pressure wound therapy dressing", "comparator": "conventional passive wound dressing", "primaryOutcome": "rate of wound reopening (dehiscence) after surgery", "result": "no difference in wound reopening, healing time, or return to normal activities between the two dressing types", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but small, so the results may not be very precise.", "directness": "indirect", "limitations": "abstract notes the limited population size", "followUp": "2-month postoperative online survey", "plainFinding": "No difference in recovery time.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39393119/", "sourceText": "INTRODUCTION: Surgically treated pilonidal sinus disease (PSD) has high rates of postoperative wound complications, with surgical wound dehiscence (SWD) rates up to 44%. Negative pressure wound therapy (NPWT) is proposed to reduce rates of SWD for other high risk surgical wounds. Our aim was to investigate whether NPWT would reduce rates of SWD compared to conventional passive (CP) dressings for PSD excisions with off-midline primary closure. Our secondary outcomes included patient quality of life and time taken return to normal activities. METHOD: We performed a prospective, crossover pediatric/adult randomized controlled trial for patients (12-40 y) with PSD, requiring excision and off-midline primary closure. Participants were randomized to receive a CP (Primapore or Opsite) or NPWT (SNAP) dressing. Follow-up occurred on D3, D7, D10, D14 and then weekly until wound healing. Patients were sent a 2-month postoperative online survey to assess quality of life outcomes. RESULTS: Fifty patients were recruited, 25 to NPWT & 25 to CP. Mean age and body mass index were 22.6 ± 6.7 y and 26.1 ± 4.5 kg/m2, respectively. 36/50 (76%) were male. The overall dehiscence rate was 42% (21/50); 12/25 (48%) for NPWT & 9/25 (36%) for CP, P = 0.6. Five deep (≥5 mm) SWDs occurred in each group, P > 0.9. SWD was associated with increased excision dimensions in the NPWT group only, P = 0.03. Median duration to wound healing was equivalent in nondehisced wounds, (CP 21.0 [14.0-29.5] versus NPWT 21.0 [16.0-24.0] days, P = 0.7). There were no differences in mean time to the following: return to school/work (NPWT 26.1 ± 18.2 versus CP 29.3 ± 14.7 d, P = 0.6), sit normally (NPWT 22.3 ± 16.2 versus CP 20.1 ± 9.4 d, P = 0.7), or return to physical activity (NPWT21.6 ± 17.2 versus CP40.3 ± 2.4 d, P = 0.2). CONCLUSIONS: NPWT did not improve outcomes after excision of PSD with off-midline primary closure. Despite the limited population size, our results do not support its use as a routine preventative measure.", "provenance": [ { "field": "population", "quote": "patients (12-40 y) with PSD, requiring excision and off-midline primary closure" }, { "field": "n", "quote": "Fifty patients were recruited, 25 to NPWT & 25 to CP." }, { "field": "intervention", "quote": "NPWT (SNAP) dressing" }, { "field": "comparator", "quote": "CP (Primapore or Opsite)" }, { "field": "primaryOutcome", "quote": "Our aim was to investigate whether NPWT would reduce rates of SWD compared to conventional passive (CP) dressings" }, { "field": "result", "quote": "Median duration to wound healing was equivalent in nondehisced wounds, (CP 21.0 [14.0-29.5] versus NPWT 21.0 [16.0-24.0] days, P = 0.7). There were no differences in mean time to the following: return to school/work (NPWT 26.1 ± 18.2 versus CP 29.3 ± 14.7 d, P = 0.6)" }, { "field": "followUp", "quote": "Patients were sent a 2-month postoperative online survey to assess quality of life outcomes." }, { "field": "limitations", "quote": "Despite the limited population size, our results do not support its use as a routine preventative measure." } ] }, { "id": "pmid:39145895", "pmid": "39145895", "doi": "10.1007/s00383-024-05821-x", "nctId": null, "pmcid": null, "title": "Management and outcomes of pilonidal patients with secondary sinuses-a cohort study", "firstAuthor": "Liang", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2024, "design": "prospective-cohort", "n": 105, "nField": "reported", "population": "teenagers and young adults with pilonidal disease and a draining secondary sinus tract", "intervention": "surgical removal of the pilonidal tract (Gips procedure) along with excision of the secondary sinus", "comparator": "", "primaryOutcome": "whether drainage or pain came back after surgery, and how long it took to resolve", "result": "After surgery, 7.5% of patients had drainage come back from the secondary sinus site, taking a median of about 72 days to resolve; recurrent full pilonidal disease occurred in under 6% of patients", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This was a single-group follow-up study without a comparison treatment, so it can describe recovery time but not whether this approach works better than other options.", "directness": "indirect", "limitations": "No control group, single surgical technique (Gips procedure) studied, and the population already had a more severe form of disease (concurrent secondary sinus) which may not reflect typical pilonidal cyst drainage.", "followUp": "367.0 days", "plainFinding": "Drainage recurrence resolved in about 72 days.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/39145895/", "sourceText": "BACKGROUND: Patients with pilonidal disease (PD) can present with concurrent draining secondary sinus at the superior gluteal cleft. The natural disease course in the setting of this severe phenotype is poorly characterized. We present the largest cohort of patients with PD and concurrent secondary sinus. METHODS: Patients with PD and concurrent secondary sinus who underwent Gips procedure with secondary sinus excision from 2019 to 2023 were prospectively followed. Patient demographics, drainage recurrence, symptom resolution, treatment, and follow-up period were recorded. Recurrent drainage from previous secondary sinus site was defined as isolated painless serous drainage after the wound had closed for > 3 weeks; recurrent PD was characterized as recurrent pain and bloody drainage after excision. RESULTS: One hundred and five patients (seventy-one males) with a median age of 17.2 years [interquartile range (IQR):15.4-19.0] underwent excision of their disease and were followed for a median of 367.0 days (IQR: 173.2-658.8). Without regular epilation, six patients (5.7%, five males, one female) had recurrent PD. With regular epilation, three patients (2.8%, three males) had recurrent PD. Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage. Median time to recurrent drainage was 75.5 days (IQR: 65.2-216.2) after excision and for recurrent drainage to resolve was 72 days (IQR: 49-81). Recurrent secondary sinus site drainage was treated with antibiotics, silver nitrate, debridement, or no treatment. CONCLUSION: Patients who present with PD in the setting of concurrent secondary sinus have a unique, more severe disease phenotype. Excision can be complicated by recurrent drainage from the secondary sinus site that can resolve without repeat surgical excision.", "provenance": [ { "field": "n", "quote": "One hundred and five patients (seventy-one males) with a median age of 17.2 years" }, { "field": "population", "quote": "Patients with pilonidal disease (PD) can present with concurrent draining secondary sinus at the superior gluteal cleft." }, { "field": "intervention", "quote": "underwent Gips procedure with secondary sinus excision from 2019 to 2023" }, { "field": "primaryOutcome", "quote": "drainage recurrence, symptom resolution, treatment, and follow-up period were recorded" }, { "field": "result", "quote": "Eight patients (7.5%, six males, two females) had recurrent secondary sinus site drainage. Median time to recurrent drainage was 75.5 days (IQR: 65.2-216.2) after excision and for recurrent drainage to resolve was 72 days (IQR: 49-81)." }, { "field": "followUp", "quote": "were followed for a median of 367.0 days (IQR: 173.2-658.8)" } ] }, { "id": "pmid:37691134", "pmid": "37691134", "doi": "10.1111/iwj.14353", "nctId": null, "pmcid": "PMC10784422", "title": "Simplified and modified Limberg flap plus vacuum-assisted closure for treatment of sacrococcygeal pilonidal sinus disease", "firstAuthor": "Xu", "multipleAuthors": true, "journal": "Int Wound J", "year": 2024, "design": "case-series", "n": 96, "nField": "reported", "population": "young adults (mostly male) with pilonidal sinus disease at the base of the spine", "intervention": "a modified flap surgery (Limberg flap) combined with vacuum-assisted wound closure", "comparator": "none - all patients received the same surgery, no comparison group", "primaryOutcome": "time until patients returned to normal daily activities, plus wound healing complications and recurrence", "result": "average time to resume daily activities was 26.3 days, average hospital stay 19.4 days, no recurrences, and 6.3% had wound dehiscence", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This was a single-group study with no comparison treatment, and the publication has since been retracted, so it cannot reliably show how this treatment compares to anything else.", "directness": "indirect", "limitations": "No control group for comparison, single center, and the paper has been formally retracted.", "followUp": "", "plainFinding": "Resumed daily activities in about 26 days.", "retracted": true, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37691134/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum-assisted closure for treating PSD. METHODS: This prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area. RESULTS: The volume of resected diseased tissue was 13.5-120 (mean ± SD, 34.993 ± 24.406) cm2 . The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow-up. None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points. CONCLUSIONS: Simplified modified Limberg flap reconstruction with vacuum-assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.", "provenance": [ { "field": "n", "quote": "The 96 patients ranged in age from 15 to 34 years" }, { "field": "population", "quote": "Pilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults" }, { "field": "intervention", "quote": "simplified modified Limberg flap reconstruction with vacuum-assisted closure" }, { "field": "comparator", "quote": "all patients underwent simplified modified Limberg flap reconstruction with vacuum-assisted closure" }, { "field": "primaryOutcome", "quote": "time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded" }, { "field": "result", "quote": "The mean time to the resumption of daily activities was 26.3 days." }, { "field": "result", "quote": "None of the patients experienced post-operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft." } ] }, { "id": "pmid:37218401", "pmid": "37218401", "doi": "10.1111/iwj.14218", "nctId": null, "pmcid": "PMC10588358", "title": "Effect of sinus resection combined with vacuum-assisted closure on sacrococcygeal pilonidal sinus", "firstAuthor": "Liu", "multipleAuthors": true, "journal": "Int Wound J", "year": 2023, "design": "rct", "n": 62, "nField": "reported", "population": "patients with sacrococcygeal pilonidal sinus", "intervention": "sinus resection combined with vacuum-assisted closure (closed negative pressure drainage) of the wound", "comparator": "simple sinus resection and suture", "primaryOutcome": "time to return to normal activity (return time), along with hospital stay, pain, complications, and recurrence", "result": "the vacuum-assisted closure group had significantly shorter hospital stay and return time, less pain, and fewer complications, though the abstract gives contradictory statements about recurrence rates between groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "the abstract describes patients as 'randomly divided' but also calls the work a 'retrospective analysis', and it contains internally contradictory recurrence rate statements, making the findings hard to trust.", "directness": "indirect", "limitations": "small sample size, confusing/contradictory description of design (randomized vs retrospective) and contradictory recurrence data within the same abstract", "followUp": "six months", "plainFinding": "Faster recovery with wound vacuum therapy.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37218401/", "sourceText": "This study was aimed at investigating the effect of sinus removal combined with vacuum-assisted closure in the treatment of sacrococcygeal pilonidal sinus. From January 2019 to May 2022, 62 patients with sacrococcygeal pilonidal sinus were treated and their information was collected at our hospital. These patients were randomly divided into two groups: an observation group (n = 32) and a control group (n = 30). The control group underwent a simple sinus resection and suture, while the observation group received a sinus resection combined with closed negative pressure drainage of the wound. A retrospective analysis of the data obtained was conducted. Perioperative indicators, clinical efficacy, postoperative pain, complications, aesthetic effects, and satisfaction scores at six months after the operation were compared between the two groups, and the recurrence rate at six months after the operation was recorded. Through this study, we found that the observation group had significantly shorter surgery time, hospital stay, and return time compared with the control group (P < 0.05). Additionally, the observation group had a higher overall recurrence rate (ORR) of 100.00%, which was significantly better than the control group's ORR of 86.67% (P < 0.05). The visual analog scale (VAS) score at 6, 12, and 24 h after the operation was significantly lower in the observation group compared with the control group (P < 0.05). Although the differences were not significant (P > 0.05), the observation group had decreased white blood cell, neutrophil, and C-reactive protein levels after the operation. Moreover, the total occurrence rate of postoperative complications in the observation group was significantly lower (6.25%) than that of the control group (26.67%; P < 0.05). The observation group also had significantly lower scores on the postoperative scar scale and higher satisfaction scores than the control group (P < 0.05). However, there was no significant difference in the postoperative recurrence rate between the two groups (P > 0.05). Our study demonstrated that sinus resection combined with vacuum-assisted closure was more effective in treating sacrococcygeal pilonidal sinus compared with simple sinus resection and suture. This approach significantly reduced surgery time, hospital stay, and return time. It also effectively relieved postoperative pain, reduced the occurrence of postoperative complications, resulted in smaller postoperative scars, and yielded better aesthetic outcomes and higher patient satisfaction.", "provenance": [ { "field": "n", "quote": "62 patients with sacrococcygeal pilonidal sinus were treated and their information was collected" }, { "field": "population", "quote": "patients with sacrococcygeal pilonidal sinus" }, { "field": "intervention", "quote": "sinus resection combined with closed negative pressure drainage of the wound" }, { "field": "comparator", "quote": "simple sinus resection and suture" }, { "field": "primaryOutcome", "quote": "Perioperative indicators, clinical efficacy, postoperative pain, complications, aesthetic effects, and satisfaction scores at six months after the operation were compared" }, { "field": "result", "quote": "the observation group had significantly shorter surgery time, hospital stay, and return time compared with the control group (P < 0.05)" }, { "field": "result", "quote": "there was no significant difference in the postoperative recurrence rate between the two groups (P > 0.05)" }, { "field": "result", "quote": "the observation group had a higher overall recurrence rate (ORR) of 100.00%, which was significantly better than the control group's ORR of 86.67%" } ] }, { "id": "pmid:37017164", "pmid": "37017164", "doi": null, "nctId": null, "pmcid": null, "title": "Surgical Outcome of Limberg's Flap Reconstruction in the Treatment of Pilonidal Sinus Disease in a Community Hospital", "firstAuthor": "Karki", "multipleAuthors": true, "journal": "Kathmandu Univ Med J (KUMJ)", "year": 2022, "design": "case-series", "n": 42, "nField": "reported", "population": "young adults with pilonidal sinus disease, mostly male, aged 16-31", "intervention": "Limberg's flap reconstruction surgery", "comparator": "", "primaryOutcome": "surgical outcomes including hospital stay, complications, and return to work", "result": "mean days for return to work was 14.5±5.7 days, with a 9.52% complication rate and no recurrence", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a small single-arm study of 42 patients with no comparison group, so it cannot show whether this procedure is better or worse than other treatments.", "directness": "indirect", "limitations": "No control or comparison group; small sample size; single hospital setting; studies a complex flap procedure rather than simple incision and drainage", "followUp": "", "plainFinding": "Back to work in about 2 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/37017164/", "sourceText": "Background Pilonidal sinus disease is an acquired condition that commonly arises in the hair follicles of the gluteal cleft with male predominance. Different treatment modalities have been described in the literature ranging from simple incision and drainage, wide local excision to complex plastic flaps. Objective To evaluate the efficacy and outcome of Limberg's flap reconstruction in a community hospital. Method This is a prospective study conducted over two-year duration in forty-two patients in the department of Surgery at Dhulikhel Hospital Kathmandu University Hospital from January 2017 till December 2018. Result Total of 42 patients were operated ranging from 16-31 years with mean of 22.86 years, male to female ratio was 7.5:1, 52% were students and 19% were drivers. Mean operative duration was 61.86±25.3 minutes, length of hospital stay was 2.83±1.68 days, mean duration of drain in situ was 4±1.34 days, mean days for return to work was 14.5±5.7. We had a complication rate of 9.52% out of which 4.76% had seroma, 2.38% hematoma, 2.38% wound infection, and there was no flap necrosis or recurrence. Conclusion It is a simple, easy to learn and safe procedure with good cosmetic results and low recurrence rate. It can be considered as an alternative to other flap and plasty procedures.", "provenance": [ { "field": "population", "quote": "forty-two patients" }, { "field": "population", "quote": "ranging from 16-31 years with mean of 22.86 years" }, { "field": "intervention", "quote": "Limberg's flap reconstruction" }, { "field": "primaryOutcome", "quote": "To evaluate the efficacy and outcome of Limberg's flap reconstruction" }, { "field": "result", "quote": "mean days for return to work was 14.5±5.7" }, { "field": "result", "quote": "We had a complication rate of 9.52% out of which 4.76% had seroma, 2.38% hematoma, 2.38% wound infection, and there was no flap necrosis or recurrence" }, { "field": "n", "quote": "Total of 42 patients were operated" } ] }, { "id": "pmid:36542008", "pmid": "36542008", "doi": "10.1590/0102-672020220002e1713", "nctId": null, "pmcid": "PMC9767422", "title": "RADICAL VERSUS CONSERVATIVE METHODS IN ONE-STAGE PILONIDAL ABSCESS SURGERY: THE EXPERIENCE OF A TUNISIAN CENTER", "firstAuthor": "Mahjoubi", "multipleAuthors": true, "journal": "Arq Bras Cir Dig", "year": 2022, "design": "retrospective", "n": 57, "nField": "reported", "population": "adults with a pilonidal abscess needing surgery", "intervention": "complete excision (radical) surgery", "comparator": "incision, drainage or curettage (conservative) surgery", "primaryOutcome": "time to return to normal activity, wound healing time, and recurrence", "result": "excision took longer to return to activity but had fewer recurrences; incision healed the wound faster but recurred more often", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a small retrospective comparison of 57 patients without randomization, so differences could be due to other factors.", "directness": "direct", "limitations": "small sample size, not randomized, relies partly on patient interviews and medical records", "followUp": "", "plainFinding": "Excision: slower recovery, fewer recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36542008/", "sourceText": "BACKGROUND: Surgical treatment for pilonidal abscess is the gold standard, but not yet well codified. Different techniques proposed can be conservative or radical. AIMS: The aim of our study was to compare postoperative outcomes of both methods in one-stage treatment strategy. METHODS: This is a comparative study including patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up, over a period of 4 years. We looked for the occurrence of postoperative recurrence in the medical records or by interviewing reachable patients. RESULTS: We analyzed 57 patients: 33 males and 24 females. The mean age was 26.9±10 years. The type of operation was excision in 46 (81%) cases and incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case. There was no statistically significant relationship between the type of surgery and the occurrence of postoperative surgical complications (p=1) and hospital stay (p=0.4). Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04). Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001). The recurrence rate was 19% in radical surgery and 54% in conservative surgery. Radical surgery was significantly associated with a lower recurrence rate than incision procedure (p=0.02). CONCLUSIONS: Excision of pilonidal abscess was the common technique in our series, with a significantly lower rate of recurrence of the disease than after incision. However, the long convalescence following excision and the longer operating time, particularly in an emergency context, may sometimes lead to choosing conservative surgery.", "provenance": [ { "field": "n", "quote": "We analyzed 57 patients: 33 males and 24 females." }, { "field": "population", "quote": "patients operated on for pilonidal abscess, with a satisfactory postoperative follow-up" }, { "field": "intervention", "quote": "The type of operation was excision in 46 (81%) cases" }, { "field": "comparator", "quote": "incision in 11 (19%) cases associated with curettage in three cases and drainage in 1 case" }, { "field": "primaryOutcome", "quote": "Excision of pilonidal abscess was significantly associated with a longer time to return to activity (p=0.04)." }, { "field": "result", "quote": "Conservative surgery was significantly associated with faster healing of the surgical wound (p<0.001). The recurrence rate was 19% in radical surgery and 54% in conservative surgery." } ] }, { "id": "pmid:36102566", "pmid": "36102566", "doi": "10.1097/XCS.0000000000000356", "nctId": null, "pmcid": null, "title": "Resolution of Mild Pilonidal Disease in Adolescents Without Resection", "firstAuthor": "Check", "multipleAuthors": true, "journal": "J Am Coll Surg", "year": 2022, "design": "case-series", "n": 102, "nField": "reported", "population": "adolescents and young adults with mild pilonidal disease", "intervention": "improved hygiene, excision of pits under local anesthesia, and laser ablation of follicles", "comparator": "none - no comparison group, single-arm case series", "primaryOutcome": "resolution of pilonidal disease", "result": "77 of 78 patients who continued care had resolution after a mean treatment duration of 30 ± 19 weeks", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-arm case series with no comparison group and nearly a quarter of patients lost to follow-up, so it can't reliably show how this approach compares to simple drainage.", "directness": "indirect", "limitations": "24 of 102 patients were lost to follow up; no control group; only 41% had prior incision and drainage, so most patients did not have simple drainage as their treatment.", "followUp": "30 ± 19 weeks", "plainFinding": "Resolved after months of combined care", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/36102566/", "sourceText": "BACKGROUND: Pilonidal disease is a common condition of the gluteal crease, affecting around 1 in 2,000 adolescents and young adults. 1 Traditional options for management of pilonidal disease include improved hygiene with or without hair removal or resection of the nidus. Given a high recurrence rate associated with hygiene alone, nidus resection is often recommended, even for patients with mild pilonidal disease, despite significant postoperative morbidity. We present a consecutive series of patients with mild pilonidal disease managed in a dedicated Pilonidal Care Clinic using an alternate approach directed toward source control: improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming. 2. STUDY DESIGN: Data on demographics, disease severity, symptom scoring, treatments provided, and outcome for consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease between August 2017 and September 2020 were analyzed. RESULTS: One hundred two patients presented; their mean age was 16.3 years, 56 (55%) were female, and 42 (41%) had undergone prior nidus incision and drainage. Twenty-four were lost to follow up, and 77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks. CONCLUSION: Mild pilonidal disease may be resolved with improved hygiene, pit excision, and laser epilation with minimal morbidity and no activity restrictions. Adoption of this approach may keep a large number of patients with pilonidal disease from undergoing unindicated resection.", "provenance": [ { "field": "population", "quote": "consecutive new patients presenting to an outpatient pilonidal care clinic with mild disease" }, { "field": "intervention", "quote": "improved hygiene to limit debris in the gluteal crease, excision of midline pilonidal pits under local anesthesia to prevent intrusion of debris with drainage of any nidus present, and laser ablation of midline follicles to prevent new pits from forming" }, { "field": "comparator", "quote": "an alternate approach directed toward source control" }, { "field": "primaryOutcome", "quote": "resolution of their pilonidal disease" }, { "field": "result", "quote": "77 of the 78 who continued care had resolution of their pilonidal disease after a mean of 3 ± 2.5 laser epilations and 1.3 ± 1 pit excisions during 4 ± 2 clinic visits over a treatment duration of 30 ± 19 weeks" }, { "field": "n", "quote": "One hundred two patients presented" } ] }, { "id": "pmid:34455675", "pmid": "34455675", "doi": "10.1111/codi.15890", "nctId": null, "pmcid": null, "title": "Negative pressure wound therapy following excision of pilonidal sinus disease: A retrospective review", "firstAuthor": "Hannan", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2021, "design": "retrospective", "n": 61, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "complete surgical excision followed by negative pressure wound therapy (NPWT)", "comparator": "none reported; single group, no comparison treatment", "primaryOutcome": "wound recurrence and failure to heal", "result": "all wounds healed, median healing time 28 days, 1.6% recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study of one group of patients with no comparison treatment, so it can't show if this approach is better than others.", "directness": "indirect", "limitations": "Retrospective design, single-arm with no comparator group, from one centre.", "followUp": "", "plainFinding": "Healed in about 4 weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34455675/", "sourceText": "AIM: There is no agreed definitive surgical treatment for pilonidal sinus disease (PSD) with several techniques in use with varying success. Negative pressure wound therapy (NPWT) is used to accelerate wound healing but literature in the context of PSD remains sparse. The aim of this study was to evaluate outcomes in patients with PSD treated by a standardised technique of complete surgical excision followed by the application of NPWT. METHODS: A retrospective observational cohort study of all patients with PSD managed by complete surgical excision followed by application of NPWT was performed over a five year period. The primary endpoints were PSD recurrence and failed wound healing. RESULTS: Sixty-one patients underwent treatment during the study period. There was 100% compliance with NPWT. All patients' wounds healed successfully, with the median time to healing being 28 days. One patient (1.6%) developed recurrent PSD and required further surgery. Two patients (3.3%) developed postoperative wound infections. Five patients, who had been managed previously by other operative approaches and subsequently developed recurrence, were successfully managed by this technique. Most patients (52.4%) were managed as a day case procedure. CONCLUSIONS: Surgery for PSD should have low recurrence rates, prompt wound healing, minimal complications, short inpatient lengths of stay and be tolerated by the patient. Our results demonstrate that our technique meets these criteria. To our knowledge, this study contains the largest number of patients with PSD managed by excision and NPWT in the literature.", "provenance": [ { "field": "population", "quote": "patients with PSD" }, { "field": "intervention", "quote": "complete surgical excision followed by the application of NPWT" }, { "field": "comparator", "quote": "A retrospective observational cohort study of all patients with PSD managed by complete surgical excision followed by application of NPWT was performed" }, { "field": "primaryOutcome", "quote": "The primary endpoints were PSD recurrence and failed wound healing." }, { "field": "result", "quote": "All patients' wounds healed successfully, with the median time to healing being 28 days. One patient (1.6%) developed recurrent PSD and required further surgery." }, { "field": "n", "quote": "Sixty-one patients underwent treatment during the study period." } ] }, { "id": "pmid:34256587", "pmid": "34256587", "doi": "10.12968/jowc.2021.30.Sup7.S28", "nctId": null, "pmcid": null, "title": "Surgical reconstruction of pilonidal sinus disease with concomitant extracellular matrix graft placement: a case series", "firstAuthor": "Chaffin", "multipleAuthors": true, "journal": "J Wound Care", "year": 2021, "design": "case-series", "n": 6, "nField": "reported", "population": "patients with recurrent pilonidal sinus disease after failed prior surgery", "intervention": "surgical flap reconstruction with extracellular matrix graft implantation", "comparator": "none, single-arm case series", "primaryOutcome": "time to full wound healing and recurrence", "result": "all but one patient fully healed by 3 weeks, the last by 4 weeks, and all remained healed at 12 weeks", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was a tiny, uncontrolled case series of only six patients, so the results can't reliably predict what happens in other patients.", "directness": "indirect", "limitations": "Very small number of participants; retrospective design; no comparison group.", "followUp": "12 weeks", "plainFinding": "Healed within 3 to 4 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/34256587/", "sourceText": "BACKGROUND: Pilonidal sinus disease (PSD) is a chronic inflammatory disease affecting the soft tissue of the sacrococcygeal region and remains a challenging disease for clinicians to treat. The optimal treatment for PSD remains controversial and recent reports describe several different surgical approaches offering different benefits. Approximately 40% of initial incision and drainage cases require subsequent surgery. Due to high recurrence rates and postoperative complications, a more complex revision surgery involving a flap reconstruction may be required. We hypothesised that the combination of an extracellular matrix (ECM) graft with tissue flap reconstruction may decrease the postoperative complications and recurrence rates for PSD. METHOD: We report a retrospective case series using a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure for recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease. RESULTS: The case series included six patients. After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks. All patients achieved good cosmesis and were able to return to normal function without any residual symptoms. CONCLUSION: This pilot case series explored augmenting a flap reconstruction for complex PSD with advanced ECM graft materials, demonstrating that it may improve outcomes and minimise typical complications seen in flap closure, such as inflammation, infection, haematoma/seroma and hypoperfusion. Although the study had a limited number of participants, long-term outcomes were promising and suggest that further studies are warranted.", "provenance": [ { "field": "n", "quote": "The case series included six patients." }, { "field": "population", "quote": "recurrent PSD, where previously surgical intervention had failed due to wound dehiscence and/or recurrent disease" }, { "field": "intervention", "quote": "surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft under a fasciocutaneous flap with an off-midline closure" }, { "field": "comparator", "quote": "We report a retrospective case series using a surgical flap reconstruction with concomitant implantation of an ovine forestomach ECM graft" }, { "field": "primaryOutcome", "quote": "After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks." }, { "field": "result", "quote": "After three weeks, all patients except one were fully healed, and the sixth was fully healed by week 4; all wounds remained fully healed at 12 weeks." } ] }, { "id": "pmid:33298356", "pmid": "33298356", "doi": "10.1016/j.jemermed.2020.10.043", "nctId": null, "pmcid": null, "title": "Abscess Management: An Evidence-Based Review for Emergency Medicine Clinicians", "firstAuthor": "Menegas", "multipleAuthors": true, "journal": "J Emerg Med", "year": 2021, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with abscesses treated in the emergency department, including pilonidal abscesses", "intervention": "incision and drainage, with alternatives like needle aspiration and antibiotics", "comparator": "different abscess management strategies compared to each other", "primaryOutcome": "abscess management outcomes", "result": "Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a narrative review summarizing general abscess management, not a study measuring recovery time after pilonidal cyst drainage specifically.", "directness": "indirect", "limitations": "Abstract does not report recovery time, study design details, or sample sizes for pilonidal abscess management specifically.", "followUp": "", "plainFinding": "No recovery time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33298356/", "sourceText": "BACKGROUND: Abscesses are commonly evaluated and managed in the emergency department. Recent research has evaluated the use of ultrasonography, packing, incision and drainage (I&D), and antibiotics. There are evidence-based nuances to the management of specific types of abscesses, such as Bartholin, breast, dental, hidradenitis suppurativa, peritonsillar, and pilonidal abscesses. OBJECTIVE: This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department. DISCUSSION: Ultrasound is valuable in diagnosing abscesses that are not clinically evident and in guiding I&D procedures. Although I&D is traditionally followed by packing, this practice may be unnecessary for small abscesses. Antibiotics, needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics. Oral antibiotics can improve outcomes after I&D, although this improvement must be weighed against potential risks. Many strategies are useful in managing Bartholin abscesses, with the Word catheter proving consistently effective. Needle aspiration is the recommended first-line therapy for small breast abscesses. Dental abscesses are often diagnosed with clinical examination alone, but ultrasound may be a useful adjunct. Acute abscess formation caused by hidradenitis suppurativa should be managed surgically by excision when possible, because I&D has a high rate of abscess recurrence. Peritonsillar abscesses can be diagnosed with either intraoral or transcervical ultrasound if clinical examination is inconclusive. Needle aspiration and I&D are both suitable for the management of peritonsillar abscesses. Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative. CONCLUSIONS: This review evaluates the recent literature surrounding abscess management for emergency medicine clinicians.", "provenance": [ { "field": "population", "quote": "Abscesses are commonly evaluated and managed in the emergency department" }, { "field": "intervention", "quote": "incision and drainage (I&D)" }, { "field": "comparator", "quote": "needle aspiration, and loop drainage are suitable alternatives to I&D of abscesses with certain characteristics" }, { "field": "primaryOutcome", "quote": "This review provides emergency medicine clinicians with a summary of the current literature regarding abscess management in the emergency department" }, { "field": "result", "quote": "Pilonidal abscesses have traditionally been managed with I&D, but needle aspiration with antibiotics may be a suitable alternative." } ] }, { "id": "pmid:33011845", "pmid": "33011845", "doi": "10.1007/s00384-020-03767-9", "nctId": null, "pmcid": null, "title": "Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis", "firstAuthor": "Manigrasso", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2021, "design": "retrospective", "n": 82, "nField": "reported", "population": "patients with an acute pilonidal abscess", "intervention": "early video-assisted ablation of pilonidal sinus (VAAPS) performed immediately", "comparator": "delayed VAAPS performed after initial incision and drainage", "primaryOutcome": "recurrence rate at 1-year, 3-year, and 5-year follow-up", "result": "No difference in recurrence between groups, but early treatment gave better patient satisfaction and postoperative health status", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a retrospective, propensity-matched comparison of two surgical timings, not a randomized trial, so results are less reliable.", "directness": "indirect", "limitations": "Retrospective design with propensity score matching rather than randomization; studies a specific endoscopic technique (VAAPS) rather than standard incision and drainage recovery.", "followUp": "5-year", "plainFinding": "Better satisfaction, similar recurrence, timing matters.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/33011845/", "sourceText": "BACKGROUND: According to the Italian Society of Colorectal Surgery guidelines, the most effective approach to the pilonidal abscess is adequate surgical drainage, concerning incision and drainage of the pilonidal cavity. Few recent studies have demonstrated that endoscopic approach could be a valid treatment option even in the case of acute pilonidal abscess. The aim of our study is to assess if video-assisted ablation of pilonidal sinus (VAAPS) could be an alternative to treat an acute pilonidal abscess and to evaluate if an immediate endoscopic approach to the pilonidal abscess is preferable to a delayed procedure after incision and drainage. METHODS: All consecutive patients with an acute pilonidal abscess since 1 January 2014 to 31 December 2018 were enrolled in our propensity score-matched analysis and divided into two groups: the early VAAPS group and the delayed VAAPS group. Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up. Secondary outcomes were time off, time to wound healing, incomplete wound healing, perioperative infection, patients' satisfaction 1 month after the complete wound healing, and their health status before surgery and 6 months after complete wound healing. RESULTS: After the propensity score matching, 82 patients were included in the final analysis (41 in each group). No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients' satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001). CONCLUSIONS: Our results encouraged to perform an immediate endoscopic approach to an acute pilonidal abscess.", "provenance": [ { "field": "n", "quote": "82 patients were included in the final analysis (41 in each group)" }, { "field": "population", "quote": "All consecutive patients with an acute pilonidal abscess" }, { "field": "intervention", "quote": "the early VAAPS group" }, { "field": "comparator", "quote": "the delayed VAAPS group" }, { "field": "primaryOutcome", "quote": "Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up." }, { "field": "result", "quote": "No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients' satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001)." } ] }, { "id": "pmid:32250067", "pmid": "32250067", "doi": null, "nctId": null, "pmcid": null, "title": "Pilonidal sinus in pediatric age: primary vs. secondary closure", "firstAuthor": "Barrial", "multipleAuthors": true, "journal": "Cir Pediatr", "year": 2020, "design": "retrospective", "n": 57, "nField": "reported", "population": "Teenagers who had surgery to remove a pilonidal sinus", "intervention": "Closing the wound immediately after surgery (primary closure)", "comparator": "Leaving the wound open to heal on its own (secondary closure)", "primaryOutcome": "Time to full wound healing, need for dressings, wound reopening, and recurrence", "result": "Immediate closure healed faster but more often partly reopened afterward; delayed closure needed more dressings and took longer to heal", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This is a small, non-randomized comparison of two surgical techniques, so differences could be due to other factors between groups.", "directness": "indirect", "limitations": "Not randomized, groups differed in age, and it studies wound closure method after surgical excision rather than simple drainage of a cyst.", "followUp": "", "plainFinding": "Faster healing with stitched closure, more reopening.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/32250067/", "sourceText": "INTRODUCTION: Pilonidal sinus (PS) is a highly frequent condition in teenagers. There is no consensus on which type of closure should be carried out following surgical removal. Our objective is to compare primary closure (PC) results with secondary closure (SC) or deferred closure results. MATERIALS AND METHODS: Patients undergoing surgery for PS between 2013 and 2018 were studied and classified according to the type of closure. Presence of infection at removal, recurrence rate, pre- and postoperative antibiotic treat-ment, number of previous drainages, and sinus size were analyzed. RESULTS: Of the 57 patients (29 of whom women), 29 were treated using PC and 28 using SC. Mean age was 14±1 years in the PC group, and 16±1 years in the SC group. PC patients presented a postoperative partial dehiscence rate of 26%. No statistically significant differences were found between groups regarding the presence of infection at surgery, recurrence rate, postoperative antibiotic treat-ment, number of previous drainages, and sinus size (p>0.05). The SC group re-quired more postoperative dressings [4 (0-6) vs. 8 (2-11) (p<0.01)] and longer time to healing [60 days (9-240) vs. 98 days (30-450) (p<0.01)]. CONCLUSIONS: 1 out of 4 PS patients with PC presents postoperative partial dehiscence. However, PC involves fewer subsequent dressings and shorter heal-ing times as compared to SC.", "provenance": [ { "field": "n", "quote": "Of the 57 patients (29 of whom women), 29 were treated using PC and 28 using SC." }, { "field": "population", "quote": "Pilonidal sinus (PS) is a highly frequent condition in teenagers." }, { "field": "intervention", "quote": "compare primary closure (PC) results" }, { "field": "comparator", "quote": "with secondary closure (SC) or deferred closure results" }, { "field": "primaryOutcome", "quote": "Presence of infection at removal, recurrence rate, pre- and postoperative antibiotic treat-ment, number of previous drainages, and sinus size were analyzed." }, { "field": "result", "quote": "The SC group re-quired more postoperative dressings [4 (0-6) vs. 8 (2-11) (p<0.01)] and longer time to healing [60 days (9-240) vs. 98 days (30-450) (p<0.01)]." }, { "field": "result", "quote": "PC patients presented a postoperative partial dehiscence rate of 26%." } ] }, { "id": "pmid:30925251", "pmid": "30925251", "doi": "10.12968/bjon.2019.28.6.S24", "nctId": null, "pmcid": null, "title": "Negative pressure wound therapy for skin graft closure in complex pilonidal disease", "firstAuthor": "de Azevedo", "multipleAuthors": true, "journal": "Br J Nurs", "year": 2019, "design": "case-series", "n": null, "nField": "not-reported", "population": "person with complex pilonidal disease", "intervention": "local excision plus negative pressure wound therapy followed by a skin graft", "comparator": "no comparator described", "primaryOutcome": "wound healing after surgery", "result": "not clearly reported in the abstract", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single case report, so it cannot show how treatments compare or how long recovery usually takes.", "directness": "indirect", "limitations": "Only one patient described; no comparison group; no clear healing time or outcome data given.", "followUp": "", "plainFinding": "Recovery details not clearly reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30925251/", "sourceText": "Pilonidal disease occurs in 26 in 100 000 people, affecting mainly men aged 20-30 years. It is treated by a variety of surgical techniques; however, there is a lack of consensus on the optimal choice of treatment for complex pilonidal disease. In addition, there is no consensus regarding care of the wound after surgery. Negative pressure wound therapy applied to open wounds following pilonidal disease surgery has been suggested as a way to decrease healing times and costs and is an emerging option for complex and or recurrent pilonidal disease. This study describes a case of complex pilonidal disease managed with local excision and negative pressure wound therapy followed by a split-thickness skin graft.", "provenance": [ { "field": "population", "quote": "a case of complex pilonidal disease" }, { "field": "intervention", "quote": "managed with local excision and negative pressure wound therapy followed by a split-thickness skin graft" }, { "field": "comparator", "quote": "This study describes a case of complex pilonidal disease managed with local excision and negative pressure wound therapy followed by a split-thickness skin graft." }, { "field": "primaryOutcome", "quote": "decrease healing times and costs" }, { "field": "result", "quote": "This study describes a case of complex pilonidal disease managed with local excision and negative pressure wound therapy followed by a split-thickness skin graft." } ] }, { "id": "pmid:30463753", "pmid": "30463753", "doi": "10.1016/j.jss.2018.06.071", "nctId": null, "pmcid": null, "title": "Recurrence of Pilonidal Disease: Our Best is Not Good Enough", "firstAuthor": "Halleran", "multipleAuthors": true, "journal": "J Surg Res", "year": 2018, "design": "retrospective", "n": 307, "nField": "reported", "population": "patients with pilonidal disease treated by pediatric surgeons", "intervention": "surgical excision or incision and drainage with/without antibiotics for pilonidal disease", "comparator": "", "primaryOutcome": "recurrence of pilonidal disease requiring further treatment", "result": "33% of patients had disease recurrence, with 80% of recurrences happening within the first year", "resultDirection": "unclear", "quality": "low", "qualityWhy": "single-center retrospective chart review without a control group, so it can describe recurrence patterns but not prove what causes them or how long healing takes.", "directness": "indirect", "limitations": "Retrospective single-center design; recurrence defined by need for further treatment, not by documented time-to-healing after drainage.", "followUp": "", "plainFinding": "High recurrence, not recovery time.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/30463753/", "sourceText": "BACKGROUND: Recurrence rates of pilonidal disease have been reported to be high as 30%. Patients with recurrent pilonidal disease often develop chronic wounds and draining sinuses that incur long-term morbidity, disability, and decreased quality of life. The aim of this study was to characterize rates of recurrence in patients with pilonidal disease treated by pediatric surgeons. METHODS: A single center retrospective review of patients with pilonidal disease evaluated by pediatric surgeons from 2010 to 2015 was performed. Recurrence of pilonidal disease was defined as an episode of active pilonidal disease that required medical or surgical intervention >30 days from the preceding treatment. Repeated events proportional hazards regression modeling was performed to identify factors associated with time to recurrence. RESULTS: Among 307 patients treated for pilonidal disease, nearly 50% were male, and the median age at initial evaluation was 16 years (IQR 15-17). Approximately 45% were obese (BMI ≥ 95th percentile). The initial treatment during the study period was surgical excision in two-thirds and incision and drainage and/or antibiotics in one-third. The overall recurrence rate was 33%, with the majority of recurrences (80%) occurring within the first year. On multivariable analysis, obese BMI was the only factor independently associated with time to disease recurrence. CONCLUSIONS: Pilonidal disease has a substantial recurrence rate even after surgical excision. Future studies investigating treatments that can prevent disease recurrence are needed.", "provenance": [ { "field": "n", "quote": "Among 307 patients treated for pilonidal disease" }, { "field": "population", "quote": "patients with pilonidal disease evaluated by pediatric surgeons" }, { "field": "intervention", "quote": "The initial treatment during the study period was surgical excision in two-thirds and incision and drainage and/or antibiotics in one-third." }, { "field": "primaryOutcome", "quote": "Recurrence of pilonidal disease was defined as an episode of active pilonidal disease that required medical or surgical intervention >30 days from the preceding treatment." }, { "field": "result", "quote": "The overall recurrence rate was 33%, with the majority of recurrences (80%) occurring within the first year." } ] }, { "id": "pmid:29529705", "pmid": "29529705", "doi": null, "nctId": null, "pmcid": null, "title": "Video-Assisted Subcutaneous Destruction of the Sinus Tract with Vessel-Loop Drainage as Minimally-Invasive Surgical Treatment for Pilonidal Sinus Disease", "firstAuthor": "Korenkov", "multipleAuthors": false, "journal": "Surg Technol Int", "year": 2018, "design": "case-series", "n": 4, "nField": "reported", "population": "people with pilonidal sinus disease, including one with an acute abscess", "intervention": "video-assisted minimally-invasive destruction of the sinus tract with vessel-loop drainage (VADST)", "comparator": "none", "primaryOutcome": "complications/adverse events after surgery", "result": "the three patients with simple pilonidal disease had no problems in the first eight weeks; the patient with an abscess developed a pus infection needing wider surgery with open healing", "resultDirection": "mixed", "quality": "very-low", "qualityWhy": "only four patients were treated, with no comparison group, so little can be concluded about typical recovery time.", "directness": "direct", "limitations": "Due to the very small number of patients in this report, we were not able to asses this technique properly.", "followUp": "eight weeks postoperatively", "plainFinding": "Mostly no problems by eight weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29529705/", "sourceText": "The video-assisted subcutaneous destruction of the sinus tract (VADST) is a novel, minimally-invasive technique for the treatment of pilonidal sinus disease (PSD). This is an advancement of the previously described subcutaneous destruction of the sinus tract and the removal of hairs as well as the long-term vessel-loop drainage of the wound channel (DST). Although the first results of this operation seemed to be promising, some of my colleagues felt that the blind approach to this procedure could be its potential \"weak point\". As a result of this critique, the procedure was enhanced with the subcutaneous video-assisted inspection of the natal cleft. Throughout most steps of VADST, like the widening of pilonidal pits with mosquito and/or Pean clamps, the subcutaneous destroying of the sinus tract, lifting the skin in a natal cleft with a curette, removing the hair with a Pean clamp and a subcutaneous vessel-loop drainage, were found to be similar to DST. The new steps involve the possibility of the video-assisted control of hair vestiges and bleedings as well as the removal of hair and debris under visual control. A rigid choledochoscope from Berci (Firma Richard Wolf GmbH, Knittlingen, Germany) was used for the subcutaneous endoscopic examination of the natal cleft area. Neither gas application nor water perfusion were necessary for this step. Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure. The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively. The patient with an acute abscess formation developed a purulent inflammation that required a wide local excision with an open-wound healing. Due to the very small number of patients in this report, we were not able to asses this technique properly. Contrary to DST, we intend to use VADST, not only for the treatment of patients with simple forms (primary pilonidal sinus without abscessed inflammation with maximal three orifices, all of them inside the navicular area), but also for the treatment of complex PSD forms.", "provenance": [ { "field": "n", "quote": "Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure." }, { "field": "population", "quote": "Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure." }, { "field": "intervention", "quote": "video-assisted subcutaneous destruction of the sinus tract (VADST) is a novel, minimally-invasive technique for the treatment of pilonidal sinus disease (PSD)" }, { "field": "comparator", "quote": "Three patients with simple forms of PSD, and one patient with an acute abscess formation, underwent the VADST procedure." }, { "field": "primaryOutcome", "quote": "The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively." }, { "field": "result", "quote": "The patients with simple forms of PSD had no adverse events during the first eight weeks postoperatively. The patient with an acute abscess formation developed a purulent inflammation that required a wide local excision with an open-wound healing." }, { "field": "limitations", "quote": "Due to the very small number of patients in this report, we were not able to asses this technique properly." }, { "field": "followUp", "quote": "no adverse events during the first eight weeks postoperatively" } ] }, { "id": "pmid:29433863", "pmid": "29433863", "doi": "10.1016/j.jss.2017.09.051", "nctId": null, "pmcid": null, "title": "Aspiration for acute pilonidal abscess-a cohort study", "firstAuthor": "Lasithiotakis", "multipleAuthors": true, "journal": "J Surg Res", "year": 2018, "design": "prospective-cohort", "n": 100, "nField": "reported", "population": "adults and teenagers with an acute pilonidal abscess", "intervention": "bedside aspiration under local anesthetic followed by oral antibiotics (cefalexin and metronidazole) for 7 days", "comparator": "no direct comparison group; traditional open incision and drainage mentioned only as background", "primaryOutcome": "need for further surgical drainage and overall patient satisfaction", "result": "83% of patients avoided needing incision and drainage, and overall satisfaction scores were high (median VAS 9 out of 10)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group study without a comparison group, with selected patients and only just over half returning satisfaction questionnaires, so it can't reliably show how recovery compares to other treatments.", "directness": "indirect", "limitations": "No control group, exclusion of patients with diabetes or skin necrosis, and only 56 of 100 patients returned satisfaction questionnaires.", "followUp": "29 (47) months", "plainFinding": "No recovery time reported; most avoided surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/29433863/", "sourceText": "BACKGROUND: The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities. The aim of this study is to assess safety, effectiveness, and patient satisfaction of aspiration followed by antibiotics for a pilonidal abscess. MATERIAL AND METHODS: All patients presenting with an acute pilonidal abscess during the period December 2010 and December 2014 in York Hospital, UK, were treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7 days. Patients with immunosuppression, diabetes, overlying skin necrosis, and perforation were excluded. Complications of the procedure were prospectively recorded. Long-term outcomes and overall patients' satisfaction were assessed with the use of mailed questionnaires and Visual Analogue Scales (VAS) (0 = not satisfied at all, 10 = very satisfied). RESULTS: One hundred sixty-nine patients presented with an acute pilonidal abscess and a total of 100 patients were treated with aspiration and antibiotics. There were 50 women (50%) and the median (interquartile range [IQR]) age of the cohort was 24 (14) years. Eleven patients had a history of a previous pilonidal procedure. Seven patients were treated successfully with a reaspiration. Overall, 10 patients required incision and drainage after a median (IQR) follow-up time of 29 (47) months. Fifty-six patients returned completed questionnaires. The median (IQR) of the VAS for the overall satisfaction of the procedure was 9 (5). CONCLUSIONS: Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates.", "provenance": [ { "field": "n", "quote": "a total of 100 patients were treated with aspiration and antibiotics" }, { "field": "population", "quote": "All patients presenting with an acute pilonidal abscess" }, { "field": "intervention", "quote": "treated with bedside aspiration under local anesthetic, followed by oral cefalexin and metronidazole for 7 days" }, { "field": "comparator", "quote": "The traditional open incision and drainage of a pilonidal abscess is associated with slow healing and delayed return to normal daily activities." }, { "field": "primaryOutcome", "quote": "Long-term outcomes and overall patients' satisfaction were assessed with the use of mailed questionnaires and Visual Analogue Scales" }, { "field": "result", "quote": "Aspiration of a pilonidal abscess in selected patients is effective in 83%, and it is associated with high overall satisfaction rates." }, { "field": "followUp", "quote": "after a median (IQR) follow-up time of 29 (47) months" } ] }, { "id": "pmid:28383451", "pmid": "28383451", "doi": "10.1097/DCR.0000000000000784", "nctId": null, "pmcid": null, "title": "Karydakis Flap With Compressing Tie-over Interrupted Sutures Without Drain versus Standard Karydakis for Treatment of Sacrococcygeal Pilonidal Sinus Disease", "firstAuthor": "Sewefy", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2017, "design": "rct", "n": 154, "nField": "reported", "population": "Adults with pilonidal sinus disease needing surgery", "intervention": "Karydakis flap surgery with tie-over compressing stitches, no drain", "comparator": "Standard Karydakis flap surgery with a drain", "primaryOutcome": "Fluid buildup, wound problems, hospital stay length, time off work, and recurrence", "result": "No-drain group left hospital same day vs 4.9 days average for drain group; less fluid buildup (0% vs 7.8%), less infection (1.3% vs 9.1%), faster return to work (10.2 vs 12.6 days), and no recurrences vs 2.6%", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It was a randomized trial but the authors say follow-up was too short to properly judge recurrence and they didn't measure pain or patient satisfaction.", "directness": "indirect", "limitations": "Postoperative pain and scar satisfaction were not measured; extent of disease was not compared between groups; follow-up duration too short to accurately assess recurrence.", "followUp": "", "plainFinding": "Faster recovery, fewer complications without drain", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28383451/", "sourceText": "BACKGROUND: Sacroccygeal pilonidal sinus disease is a worldwide health problem, affecting young adults, mainly males, with a tendency for recurrence. Various modalities have been used for treating this condition. The Karydakis procedure is one of most commonly used asymmetric flaps for treating this condition. OBJECTIVE: The study aimed to evaluate the Karydakis procedure with tie-over compressing sutures instead of the routine use of a drain in the treatment pilonidal sinus. DESIGN: This prospective randomized controlled clinical study was conducted between January 2010 and January 2015. SETTINGS: The study was conducted at Minia University Hospital. PATIENTS: The study included 154 patients. Patients were randomly assigned into 2 equal groups. INTERVENTIONS: The patients in group 1 were operated on by the standard Karydakis procedure, and the patients in group 2 were operated on by the Karydakis procedure with tie-over compressing sutures without a drain. MAIN OUTCOMES AND MEASURES: The primary outcomes measured were the incidence of seroma formation, wound complications, length of hospital stay, off-work time, and recurrence rate. RESULTS: All patients were discharged on the same day of surgery in group 2 compared with a mean hospital stay of 4.9 ± 2.4 days in group 1. No patients developed seroma in group 2 compared with 7.8% in group 1. In group 2, 1.3% of patients developed wound infection compared with 9.1% in group 1. The average time for return to work in group 2 was 10.2 ± 1.4 days compared with 12.6 ± 4 days in group 1. No recurrences were noted in group 2 compared with 2.6% in group 1. LIMITATIONS: The feedback about postoperative pain and patient satisfaction about the scar were not investigated. The extent of the disease in both groups was not investigated. The duration of follow-up too short to accurately weight recurrence rate. CONCLUSION: Karydakis flap with tie-over compressing interrupted sutures without a drain is safe, 1-day surgery with the lowest complications rate.", "provenance": [ { "field": "n", "quote": "The study included 154 patients." }, { "field": "population", "quote": "Sacroccygeal pilonidal sinus disease is a worldwide health problem, affecting young adults, mainly males" }, { "field": "intervention", "quote": "the patients in group 2 were operated on by the Karydakis procedure with tie-over compressing sutures without a drain" }, { "field": "comparator", "quote": "The patients in group 1 were operated on by the standard Karydakis procedure" }, { "field": "primaryOutcome", "quote": "The primary outcomes measured were the incidence of seroma formation, wound complications, length of hospital stay, off-work time, and recurrence rate." }, { "field": "result", "quote": "All patients were discharged on the same day of surgery in group 2 compared with a mean hospital stay of 4.9 ± 2.4 days in group 1. No patients developed seroma in group 2 compared with 7.8% in group 1. In group 2, 1.3% of patients developed wound infection compared with 9.1% in group 1. The average time for return to work in group 2 was 10.2 ± 1.4 days compared with 12.6 ± 4 days in group 1. No recurrences were noted in group 2 compared with 2.6% in group 1." } ] }, { "id": "pmid:28355137", "pmid": "28355137", "doi": null, "nctId": null, "pmcid": null, "title": "A Retrospective Study of Pilonidal Sinus Healing by Secondary Intention Using Negative Pressure Wound Therapy Versus Alginate or Gauze Dressings", "firstAuthor": "Danne", "multipleAuthors": true, "journal": "Ostomy Wound Manage", "year": 2017, "design": "retrospective", "n": 73, "nField": "reported", "population": "patients with symptomatic pilonidal sinus disease treated with open surgical wounds healing by secondary intention", "intervention": "negative pressure wound therapy (NPWT)", "comparator": "alginate-based/gauze daily dressing changes", "primaryOutcome": "time in weeks to complete wound healing (epithelialization)", "result": "median healing time was 8 weeks with NPWT versus 10 weeks with daily dressings, not a significant difference", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this was a small retrospective study without randomization, so differences in healing time could be due to other factors rather than the treatment itself", "directness": "indirect", "limitations": "retrospective design, small sample size, some patients lost to follow-up, no randomization", "followUp": "390 weeks for the DD group and 311 weeks for NPWT group", "plainFinding": "No difference in healing time.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/28355137/", "sourceText": "Pilonidal sinus (PS) disease is an inflammatory skin and subcutaneous tissue condition that presents with infection, acute abscess, chronic discharging wounds, and/or pain. Surgery with open healing by secondary intention typically is used to achieve the fastest healing time with minimal recurrence rates. A retrospective analysis was conducted of data extracted from the medical records of 73 consecutive patients who had symptomatic natal cleft PS over a 10-year period to compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence. Variables extracted included age, gender, PS wound diameter (small <1 cm, medium 1 cm to 3 cm, large >3 cm), and time in weeks to achieving the endpoint (epithelialization). Risk factors examined that can affect healing or recurrence of previously operated PS disease included initial drainage before excision and risk factors for impaired healing (morbid obesity as determined by body mass index [BMI] ≥35, chronic infective skin conditions, and ongoing therapy with immuno-modulating drugs or chemotherapy), and loss to follow-up. Data were collected and analyzed using the chi-squared statistic, Kaplan-Meier curves, and Cox regression models. The total time of follow-up was 390 weeks for the DD group and 311 weeks for NPWT group. Patient mean age was 26.5 ± 10.7 years, most (53, 72.6%) were male, and 12 (16.4%) had comorbidities potentially affecting healing. Nine (9) were treated with primary closure and 62 patients were treated with open healing by secondary intention (2 additional patients receiving DD were excluded from the analysis because they had small sinuses that made NPWT unfeasible). Among participants, 30 (48%) received DD and 32 had NPWT. The median time to healing was 10 weeks (95% CI: 7-17) in the DD group and 8 weeks (95% CI: 7-9) in the NPWT group (not significantly different). In patients who healed, the average time to healing was 15.0 ± 18.1 and 9.8 ± 6.3 weeks in the DD and NPWT groups, respectively (not significantly different). The PS wound recurred in 5 patients - 4 (12.5%) in the DD group and 1 (3.1%) in the NPWT group (P = .355). In univariate analysis, only the presence of comorbidities was found to significantly affect time to healing (HR 95%, CI: 0.40 [0.17-0.93]; P = .033]. Prospective, randomized controlled clinical studies are warranted.", "provenance": [ { "field": "n", "quote": "73 consecutive patients who had symptomatic natal cleft PS" }, { "field": "population", "quote": "73 consecutive patients who had symptomatic natal cleft PS over a 10-year period" }, { "field": "intervention", "quote": "compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence" }, { "field": "comparator", "quote": "compare use of NPWT to alginate-based/gauze daily dressing (DD) changes in terms of healing time and recurrence" }, { "field": "primaryOutcome", "quote": "time in weeks to achieving the endpoint (epithelialization)" }, { "field": "result", "quote": "The median time to healing was 10 weeks (95% CI: 7-17) in the DD group and 8 weeks (95% CI: 7-9) in the NPWT group (not significantly different)." }, { "field": "followUp", "quote": "The total time of follow-up was 390 weeks for the DD group and 311 weeks for NPWT group." } ] }, { "id": "pmid:27551895", "pmid": "27551895", "doi": "10.1308/rcsann.2016.0260", "nctId": null, "pmcid": "PMC5392818", "title": "Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess", "firstAuthor": "Jain", "multipleAuthors": true, "journal": "Ann R Coll Surg Engl", "year": 2017, "design": "prospective-cohort", "n": 19, "nField": "reported", "population": "patients with pilonidal abscess, median age 24", "intervention": "endoscopic pilonidal abscess treatment (EPAT), a minimally invasive technique", "comparator": "none (no comparison group; compared to historical conventional incision and drainage)", "primaryOutcome": "time to complete wound healing and postoperative pain", "result": "complete wound healing achieved within 6 weeks in all patients, with minimal pain and immediate return to normal activities", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small, single-center study with no comparison group, so results may not hold up in larger trials.", "directness": "direct", "limitations": "Small sample size, no control group, single center, need for larger multicentre studies as stated by authors.", "followUp": "6 weeks", "plainFinding": "Healed within 6 weeks, minimal pain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27551895/", "sourceText": "INTRODUCTION Pilonidal abscess is a common surgical emergency. Conventional treatment with incision and drainage is associated with significant postoperative morbidity. We report our initial experience of using minimally invasive endoscopic technique for the treatment of pilonidal abscesses, referred to as endoscopic pilonidal abscess treatment (EPAT). MATERIALS AND METHODS A prospective database of all patients undergoing EPAT between January 2015 and March 2016 at Whiston Hospital was maintained. Data regarding patient demographics, peroperative variables and postoperative follow-up were recorded. RESULTS Nineteen patients were included, male to female ratio was 53 : 47 and median age of the cohort was 24 years (interquartile range 22-25 years). EPAT was the primary procedure for 10 patients and 9 had EPAT for recurrent pilonidal abscesses. There were no readmissions and none needed further surgery within 6 weeks of having the procedure. In all patients, complete wound healing was achieved within 6 weeks; all reported minimal postoperative pain (median postoperative visual analogue scale score 1) and immediate return to the activities of daily life. Four of the nineteen patients (21%) required definitive intervention for pilonidal disease in the follow-up period. CONCLUSIONS EPAT is a novel, minimally invasive technique for the treatment of acute pilonidal abscesses. It is safe, associated with reduced postoperative morbidity, recurrence rate and quick wound healing. Initial encouraging results require further investigations on a larger group of patients in a multicentre setting.", "provenance": [ { "field": "n", "quote": "Nineteen patients were included" }, { "field": "population", "quote": "median age of the cohort was 24 years" }, { "field": "intervention", "quote": "endoscopic pilonidal abscess treatment (EPAT)" }, { "field": "primaryOutcome", "quote": "complete wound healing was achieved within 6 weeks" }, { "field": "result", "quote": "In all patients, complete wound healing was achieved within 6 weeks; all reported minimal postoperative pain (median postoperative visual analogue scale score 1) and immediate return to the activities of daily life." }, { "field": "comparator", "quote": "Conventional treatment with incision and drainage is associated with significant postoperative morbidity." } ] }, { "id": "pmid:27042792", "pmid": "27042792", "doi": null, "nctId": null, "pmcid": null, "title": "Subcutaneous Destruction of Sinus Tract with Long-term Vessel Loop Drainage as a Minimally Invasive Surgical Treatment for Primary Pilonidal Sinus", "firstAuthor": "Korenkov", "multipleAuthors": false, "journal": "Surg Technol Int", "year": 2016, "design": "case-series", "n": 5, "nField": "reported", "population": "patients with a first-time, uncomplicated pilonidal sinus (cyst) near the tailbone", "intervention": "minimally invasive surgery destroying the sinus tract under the skin with long-term vessel loop drainage and repeated wound checks", "comparator": "none (single-arm pilot study)", "primaryOutcome": "time to complete wound healing with good scar formation, and complications", "result": "complete healing with a good scar occurred by day 21 in 3 patients and by day 28 in 2 patients, with no abscess or recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This was an uncontrolled pilot study with only 5 patients, so it cannot reliably show how this compares to other treatments.", "directness": "direct", "limitations": "Very small pilot study (5 patients), no comparison group, described as needing further systematic testing.", "followUp": "28th postoperative day", "plainFinding": "Healed by 3-4 weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/27042792/", "sourceText": "The surgical management of pilonidal disease ranges from minimally invasive techniques to wide excision with secondary wound healing. Hypothetical counterarguments for using the minimally invasive techniques are that these techniques only incompletely remove the sinus tract and that they allow the formation of subcutaneous cavities as a result of rapid closure of small skin incisions. In order to avoid these problems we used a vessel loop drainage after subcutaneous destruction of the sinus tract. In this technique we combined two procedures: a narrow excision of pilonidal orifices with the subcutaneous destruction of the sinus tract and the removal of hair as well as the long-term vessel loop drainage of the wound channel with repeated revisions of the wound channel for removing hair remnants. In order to assess the efficacy and morbidity of this method 5 patients with primary symptomatic pilonidal sinus underwent an operation as a pilot study. Up to the removal of the vessel loop the wound channel had been regularly inspected using a mosquito clamp. If during two successive inspections no hair from the wound was found the vessel loop was removed. No adverse events occurred such as abscess or recurrent pilonidal sinus. One female patient with a history of long-term use of morphine derivatives and psychotropic substances experienced persistent coccygeal pain that persisted longer than 6 weeks. The complete wound healing with the formation of a qualitative scar took place on the 21st postoperative day (for 3 patients) and on the 28th postoperative day (for 2 patients). Initial results suggest that this operation is an effective procedure for the treatment of primary simple pilonidal sinus disease and we will continue to systematically test it.", "provenance": [ { "field": "n", "quote": "5 patients with primary symptomatic pilonidal sinus underwent an operation as a pilot study" }, { "field": "population", "quote": "5 patients with primary symptomatic pilonidal sinus" }, { "field": "intervention", "quote": "a narrow excision of pilonidal orifices with the subcutaneous destruction of the sinus tract and the removal of hair as well as the long-term vessel loop drainage of the wound channel with repeated revisions of the wound channel for removing hair remnants" }, { "field": "comparator", "quote": "5 patients with primary symptomatic pilonidal sinus underwent an operation as a pilot study" }, { "field": "primaryOutcome", "quote": "The complete wound healing with the formation of a qualitative scar took place on the 21st postoperative day" }, { "field": "result", "quote": "The complete wound healing with the formation of a qualitative scar took place on the 21st postoperative day (for 3 patients) and on the 28th postoperative day (for 2 patients)." } ] }, { "id": "pmid:26377583", "pmid": "26377583", "doi": "10.1007/s10151-015-1369-3", "nctId": null, "pmcid": null, "title": "The treatment of pilonidal disease: guidelines of the Italian Society of Colorectal Surgery (SICCR)", "firstAuthor": "Segre", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2015, "design": "guideline", "n": null, "nField": "not-reported", "population": "people with pilonidal disease", "intervention": "various treatments for pilonidal disease, including nonoperative care and surgery", "comparator": "different treatment techniques compared with each other", "primaryOutcome": "healing and recurrence after treatment", "result": "no clear benefit of one surgical technique over another, and most nonoperative studies were small and low quality", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a guideline summarizing mostly small, low-quality studies rather than a single study measuring recovery time.", "directness": "indirect", "limitations": "abstract states most supporting studies are small series with low-quality evidence; no specific data on recovery time after drainage of an abscess is given.", "followUp": "", "plainFinding": "No recovery time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26377583/", "sourceText": "The Italian Society of Colorectal Surgery (SICCR.) has prepared clinical practice guidelines to help its members to optimize the treatment of pilonidal disease, a very common condition, especially among young people, and therefore of great importance on a socioeconomic level. The SICCR committee of experts on pilonidal disease analyzed the international literature and evaluated current evidence. Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection: reported healing rates and recurrence incidence are satisfactory but the majority of studies are small series with low-quality evidence. Surgical therapy which can be divided into two categories: excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention. On the whole, no clear benefit is demonstrated for one technique over the other.", "provenance": [ { "field": "population", "quote": "pilonidal disease, a very common condition, especially among young people" }, { "field": "intervention", "quote": "Nonoperative management includes gluteal cleft shaving, laser epilation as well as fibrin glue and phenol injection" }, { "field": "comparator", "quote": "excision of diseased tissue with primary closure using different techniques or excision with healing by secondary intention" }, { "field": "primaryOutcome", "quote": "reported healing rates and recurrence incidence are satisfactory" }, { "field": "result", "quote": "On the whole, no clear benefit is demonstrated for one technique over the other." }, { "field": "result", "quote": "the majority of studies are small series with low-quality evidence" } ] }, { "id": "pmid:26054992", "pmid": "26054992", "doi": null, "nctId": null, "pmcid": null, "title": "Topical Agents and Dressings for Pilonidal Sinus Wound Healing by Secondary Intention: A Scoping Review", "firstAuthor": "Woo", "multipleAuthors": true, "journal": "Surg Technol Int", "year": 2015, "design": "systematic-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus wounds healing by secondary intention", "intervention": "various topical agents and dressings (hydrogel, silver, honey, zinc, foam, negative pressure therapy, platelet rich plasma, plant extracts)", "comparator": "", "primaryOutcome": "wound healing, bacterial burden, and pain", "result": "some evidence that certain topical agents may help healing, reduce bacteria, or ease pain, but evidence is weak", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a scoping review of studies with methodological limitations and biases, so conclusions are uncertain.", "directness": "indirect", "limitations": "evidence remains insufficient in light of methodological limitations and biases of the studies", "followUp": "", "plainFinding": "Weak evidence some dressings help healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26054992/", "sourceText": "Pilonidal disease (PD) is a chronic and debilitating condition. The overall aim of the scoping review is to map and summarize a wide range of evidence to examine which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention. Review of this cumulative body of evidence will inform care and guide dressing selection for PD related wounds and delineate future research priorities based on identified knowledge gaps and clinical practice issues. Overall, there is some evidence to suggest that topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts may promote wound healing. Topical treatment using polyhexamethylene biguanide and silver may be beneficial in reducing bacterial burden. Finally, silver, honey, and hydrocolloid dressings may help alleviate wound related pain. However, evidence remains insufficient in light of methodological limitations and biases of the studies.", "provenance": [ { "field": "population", "quote": "which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention" }, { "field": "intervention", "quote": "topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts" }, { "field": "primaryOutcome", "quote": "map and summarize a wide range of evidence to examine which topical agent or dressing is effective in promoting pilonidal wound healing by secondary intention" }, { "field": "result", "quote": "there is some evidence to suggest that topical applications of hydrogel, silver, honey, zinc, selected foam materials, negative pressure wound therapy, platelet rich plasma, and plant extracts may promote wound healing" }, { "field": "limitations", "quote": "evidence remains insufficient in light of methodological limitations and biases of the studies" } ] }, { "id": "pmid:26042534", "pmid": "26042534", "doi": "10.1002/14651858.CD011278.pub2", "nctId": null, "pmcid": "PMC10960640", "title": "Negative pressure wound therapy for treating surgical wounds healing by secondary intention", "firstAuthor": "Dumville", "multipleAuthors": true, "journal": "Cochrane Database Syst Rev", "year": 2015, "design": "systematic-review", "n": 69, "nField": "reported", "population": "people with surgical wounds left open to heal, including one study on wounds after pilonidal sinus removal", "intervention": "negative pressure wound therapy (a vacuum dressing system)", "comparator": "alginate or silicone wound dressings", "primaryOutcome": "how well and how fast the wounds healed", "result": "too little data to judge if negative pressure therapy helps wounds heal, with no clear evidence of benefit or harm", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "only two small trials with very limited data were found, so no firm conclusions can be drawn.", "directness": "indirect", "limitations": "The trials reported limited outcome data on healing, adverse events and resource use, and only one of two studies involved pilonidal wounds, not drainage specifically.", "followUp": "", "plainFinding": "Not enough evidence to tell.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/26042534/", "sourceText": "BACKGROUND: Following surgery, incisions are usually closed by fixing the edges together with sutures (stitches), staples, adhesive glue or clips. This process helps the cut edges heal together and is called 'healing by primary intention'. However, not all incised wounds are closed in this way: where there is high risk of infection, or when there has been significant tissue loss, wounds may be left open to heal from the 'bottom up'. This delayed healing is known as 'healing by secondary intention'. Negative pressure wound therapy (NPWT) is one treatment option for surgical wounds that are healing by secondary intention. OBJECTIVES: To assess the effects of negative pressure wound therapy (NPWT) on the healing of surgical wounds healing by secondary intention (SWHSI) in any care setting. SEARCH METHODS: For this review, in May 2015 we searched the following databases: the Cochrane Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials; Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations; Ovid EMBASE; and EBSCO CINAHL. There were no restrictions based on language or date of publication. SELECTION CRITERIA: Published or unpublished randomised controlled trials (RCTs) comparing the effects of NPWT with alternative treatments or different types of NPWT in the treatment of SWHSI. We excluded open abdominal wounds from this review as they are the subject of a separate Cochrane review that is in draft. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, risk of bias assessment and data extraction. MAIN RESULTS: We located two studies (69 participants) for inclusion in this review. One study compared NPWT with an alginate dressing in the treatment of open, infected groin wounds. and one study compared NPWT with a silicone dressing in the treatment of excised pilonidal sinus. The trials reported limited outcome data on healing, adverse events and resource use. AUTHORS' CONCLUSIONS: There is currently no rigorous RCT evidence available regarding the clinical effectiveness of NPWT in the treatment of surgical wounds healing by secondary intention as defined in this review. The potential benefits and harms of using this treatment for this wound type remain largely uncertain.", "provenance": [ { "field": "n", "quote": "We located two studies (69 participants) for inclusion in this review." }, { "field": "population", "quote": "one study compared NPWT with a silicone dressing in the treatment of excised pilonidal sinus" }, { "field": "intervention", "quote": "Negative pressure wound therapy (NPWT) is one treatment option for surgical wounds that are healing by secondary intention." }, { "field": "comparator", "quote": "One study compared NPWT with an alginate dressing in the treatment of open, infected groin wounds. and one study compared NPWT with a silicone dressing in the treatment of excised pilonidal sinus." }, { "field": "primaryOutcome", "quote": "To assess the effects of negative pressure wound therapy (NPWT) on the healing of surgical wounds healing by secondary intention (SWHSI) in any care setting." }, { "field": "result", "quote": "There is currently no rigorous RCT evidence available regarding the clinical effectiveness of NPWT in the treatment of surgical wounds healing by secondary intention as defined in this review. The potential benefits and harms of using this treatment for this wound type remain largely uncertain." } ] }, { "id": "pmid:25664095", "pmid": "25664095", "doi": null, "nctId": null, "pmcid": "PMC4307542", "title": "A new approach: oblique excision and primary closure in the management of acute pilonidal disease", "firstAuthor": "Ciftci", "multipleAuthors": true, "journal": "Int J Clin Exp Med", "year": 2014, "design": "prospective-cohort", "n": 128, "nField": "reported", "population": "patients with pilonidal abscesses", "intervention": "incision and drainage of the pilonidal abscess", "comparator": "oblique excision with primary closure", "primaryOutcome": "rate of chronic pilonidal sinus development and time to healing/return to work", "result": "incision and drainage healed faster (18 days) but had a much higher rate of chronic sinus formation (78.8%) than oblique excision and primary closure (6.0%, 22 days healing)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "Patients were not randomly assigned to treatment groups (each surgeon used only one method), so other differences between groups could explain the results.", "directness": "direct", "limitations": "Treatment was assigned by which surgeon saw the patient rather than randomization, raising risk of bias.", "followUp": "", "plainFinding": "Drainage healed in 18 days.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25664095/", "sourceText": "AIM: To compare incision and drainage with oblique excision and primary closure in the treatment of pilonidal abscesses. MATERIALS AND METHODS: In this prospective study, one of two surgeons at the same hospital performed incision and drainage as the treatment method for patients presenting with pilonidal abscesses. (Group A). The other surgeon performed oblique excision and primary closure (Group B). The rate of development of chronic pilonidal sinus and time to return to active work were assessed using the chi-square and Student's t-tests to compare the two methods of treatment. Of the 128 patients, incision and simple drainage was applied to 69 patients and primary closure was applied to 59 patients. RESULTS: The rate of development of chronic pilonidal sinus was 78.8% in Group A and 6.0% in Group B (P < 0.001). In Group A, the average healing time and time to return to active work were 18 and 25 days, respectively. In Group B, these times were 22 and 27 days, respectively (P < 0.001). CONCLUSION: Oblique excision and primary closure may be a preferable treatment for acute pilonidal abscesses because of its low rate of chronic sinus development.", "provenance": [ { "field": "population", "quote": "patients presenting with pilonidal abscesses" }, { "field": "intervention", "quote": "incision and drainage as the treatment method" }, { "field": "comparator", "quote": "oblique excision and primary closure" }, { "field": "primaryOutcome", "quote": "The rate of development of chronic pilonidal sinus and time to return to active work were assessed" }, { "field": "result", "quote": "In Group A, the average healing time and time to return to active work were 18 and 25 days, respectively. In Group B, these times were 22 and 27 days, respectively (P < 0.001)." }, { "field": "n", "quote": "Of the 128 patients, incision and simple drainage was applied to 69 patients and primary closure was applied to 59 patients." } ] }, { "id": "pmid:25541849", "pmid": "25541849", "doi": "10.5505/tjtes.2014.62547", "nctId": null, "pmcid": null, "title": "Comparison of early surgery (unroofing-curettage) and elective surgery (Karydakis flap technique) in pilonidal sinus abscess cases", "firstAuthor": "Kanat", "multipleAuthors": true, "journal": "Ulus Travma Acil Cerrahi Derg", "year": 2014, "design": "retrospective", "n": 53, "nField": "reported", "population": "patients treated for pilonidal sinus abscesses", "intervention": "early surgery (unroofing and curettage) right after abscess diagnosis", "comparator": "elective surgery (Karydakis flap) done later, after initial drainage and antibiotic treatment", "primaryOutcome": "treatment duration, complications, and recurrence", "result": "a statistically significant difference in how long treatment took, favoring the elective Karydakis approach", "resultDirection": "harm", "quality": "low", "qualityWhy": "it is a small retrospective comparison of only 53 patients from one clinic, so the findings are not very reliable.", "directness": "indirect", "limitations": "Retrospective design, small sample size, single clinic.", "followUp": "an average of 14 months", "plainFinding": "Early surgery took longer to heal.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25541849/", "sourceText": "BACKGROUND: The aim of this study is to compare the effectiveness and success of early (acute) period local surgical intervention (unroofing-curettage) followed by dressing and secondary healing with the surgery performed in elective conditions (pilonidal sinus excision and Karydakis flap) following conventional abscess treatment (drainage-antibiotic therapy) in pilonidal sinus abscess cases. METHODS: The data of the patients treated for pilonidal sinus abscesses in our clinic between January 2012 and March 2013 were analyzed, retrospectively. Those who had early surgery were determined as Group S, and those who had elective surgery following drainage-antibiotic therapy were determined as Group K. Patients in both groups were compared in terms of age, gender, complications, recurrence rate and healing time. Patients were followed for an average of 14 months. RESULTS: Of the 53 patients included in the study, 28 were in Group S and 25 in Group K. The mean age and gender distribution of both groups were similar and a significant difference was not found between the groups in terms of complication development and recurrence. However, there was a statistically significant difference between the groups in terms of treatment duration (p=0.02). CONCLUSION: In treating acute pilonidal abscesses, the Karydakis method, following drainage-antibiotic therapy, is a preferable method due to its shorter treatment duration and higher patient comfort.", "provenance": [ { "field": "n", "quote": "Of the 53 patients included in the study, 28 were in Group S and 25 in Group K." }, { "field": "population", "quote": "The data of the patients treated for pilonidal sinus abscesses in our clinic between January 2012 and March 2013 were analyzed, retrospectively." }, { "field": "intervention", "quote": "Those who had early surgery were determined as Group S" }, { "field": "comparator", "quote": "those who had elective surgery following drainage-antibiotic therapy were determined as Group K" }, { "field": "primaryOutcome", "quote": "Patients in both groups were compared in terms of age, gender, complications, recurrence rate and healing time." }, { "field": "result", "quote": "there was a statistically significant difference between the groups in terms of treatment duration (p=0.02)" }, { "field": "followUp", "quote": "Patients were followed for an average of 14 months." } ] }, { "id": "pmid:25380007", "pmid": "25380007", "doi": "10.1097/DCR.0000000000000240", "nctId": null, "pmcid": null, "title": "The use of negative-pressure wound therapy in pilonidal sinus disease: a randomized controlled trial comparing negative-pressure wound therapy versus standard open wound care after surgical excision", "firstAuthor": "Biter", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2014, "design": "rct", "n": 49, "nField": "reported", "population": "patients with pilonidal sinus disease after surgical excision", "intervention": "negative-pressure wound therapy (vacuum therapy) for 2 weeks after surgery", "comparator": "standard open wound care", "primaryOutcome": "time to complete wound healing", "result": "Median healing time was 84 days with vacuum therapy versus 93 days with standard care, not a significant difference; time to resume daily activities was 27 vs 29 days, also not significant", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "Small trial of only 49 patients without blinding, so the no-difference result could be due to chance.", "directness": "direct", "limitations": "small number of patients, lack of blinding to patients and doctors, and absence of patient quality-of-life evaluation", "followUp": "6 months", "plainFinding": "No faster healing or recovery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25380007/", "sourceText": "BACKGROUND: Pilonidal sinus disease is associated with significant morbidity after surgical treatment with regard to wound healing. Recent case studies suggested that negative-pressure wound therapy as primary treatment following surgical excision may shorten the duration of wound healing. OBJECTIVE: The purpose of this randomized controlled trial was to evaluate the role of vacuum therapy in pilonidal sinus disease: negative-pressure wound therapy versus standard open wound care after surgical excision. METHODS: Patients were randomly assigned to either negative-pressure wound therapy for 2 weeks or standard open wound healing. The primary end point of the study was the time to complete wound healing. Secondary end points were visual analog scale score, wound size ratio at day 14 (ie, wound healing rate), time to resume daily activities, and recurrence within 6 months after wound closure. RESULTS: Forty-nine patients were included in the study: 24 patients were treated with vacuum therapy, and 25 patients underwent standard open wound care. Complete wound healing was achieved at a median of 84 days in the vacuum therapy group versus 93 days in control patients (p = 0.44). The wound size ratio was significantly lower in the vacuum therapy group (0.30 versus 0.57, p = 0.02), ie, higher wound healing rate in the first 2 weeks. There was no difference in visual analog scale scores and disease recurrence between both groups. The time to resume full daily activities after surgery was 27 days in the patients undergoing vacuum therapy and 29 days in the control patients (p = 0.92). LIMITATIONS: This study is limited by the small number of patients, the lack of blinding to patients and doctors, and the absence of patient quality-of-life evaluation. CONCLUSION: It is feasible to apply vacuum therapy in the treatment of pilonidal sinus disease, and it has a positive effect on wound size reduction in the first 2 weeks. However, there is no difference in time to complete wound healing and time to resume daily life activities.", "provenance": [ { "field": "n", "quote": "Forty-nine patients were included in the study: 24 patients were treated with vacuum therapy, and 25 patients underwent standard open wound care." }, { "field": "population", "quote": "Pilonidal sinus disease is associated with significant morbidity after surgical treatment" }, { "field": "intervention", "quote": "Patients were randomly assigned to either negative-pressure wound therapy for 2 weeks" }, { "field": "comparator", "quote": "or standard open wound healing" }, { "field": "primaryOutcome", "quote": "The primary end point of the study was the time to complete wound healing." }, { "field": "result", "quote": "Complete wound healing was achieved at a median of 84 days in the vacuum therapy group versus 93 days in control patients (p = 0.44)." }, { "field": "result", "quote": "The time to resume full daily activities after surgery was 27 days in the patients undergoing vacuum therapy and 29 days in the control patients (p = 0.92)." } ] }, { "id": "pmid:25340864", "pmid": "25340864", "doi": null, "nctId": null, "pmcid": null, "title": "[Sinus pilonidalis - possibilities of surgical treatment]", "firstAuthor": "Jandík", "multipleAuthors": false, "journal": "Rozhl Chir", "year": 2014, "design": "retrospective", "n": 72, "nField": "reported", "population": "patients with pilonidal disease needing surgery", "intervention": "excision with rhomboid fasciocutaneous flap closure", "comparator": "excision with primary suture closure", "primaryOutcome": "surgical site infection, drainage time, hospital stay, and overall healing time", "result": "the flap method had significantly less infection, shorter drainage, shorter hospital stay, and faster overall healing", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single surgeon's retrospective comparison of two time periods, not a randomized trial, so bias and confounding are likely.", "directness": "indirect", "limitations": "Abstract does not mention randomization, blinding, or control for other differences between the two time periods.", "followUp": "", "plainFinding": "Flap surgery healed faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/25340864/", "sourceText": "INTRODUCTION: The author presents current knowledge about the therapy of pilonidal disease and compares it to his own experience with a group of patients treated for this disease in the period 20072014. MATERIAL AND METHODS: 169 patients with symptoms of pilonidal disease were treated; in 72 cases, surgery was indicated because of chronic state or recurrence of the disease. In 20072012, radical excision of sinus with primary suture of the defect was performed in 42 cases. In the period 20122014, 30 patients were operated on and the defect after excision was closed by rhomboid fasciocutaneous flap. RESULTS: When both methods of defect closure were compared, the second method showed significantly less surgical site infections, shorter time of drainage and hospitalization and overall healing. CONCLUSION: Closing the defect with rhomboid flap seems to be the optimal method for the surgical approach to pilonidal disease.", "provenance": [ { "field": "n", "quote": "in 72 cases, surgery was indicated because of chronic state or recurrence of the disease" }, { "field": "population", "quote": "169 patients with symptoms of pilonidal disease were treated" }, { "field": "intervention", "quote": "the defect after excision was closed by rhomboid fasciocutaneous flap" }, { "field": "comparator", "quote": "radical excision of sinus with primary suture of the defect was performed in 42 cases" }, { "field": "primaryOutcome", "quote": "the second method showed significantly less surgical site infections, shorter time of drainage and hospitalization and overall healing" }, { "field": "result", "quote": "the second method showed significantly less surgical site infections, shorter time of drainage and hospitalization and overall healing" } ] }, { "id": "pmid:24426457", "pmid": "24426457", "doi": "10.1007/s12262-012-0489-5", "nctId": null, "pmcid": "PMC3726804", "title": "Limberg flap for sacrococcygeal pilonidal sinus a safe and sound procedure", "firstAuthor": "Aithal", "multipleAuthors": true, "journal": "Indian J Surg", "year": 2013, "design": "prospective-cohort", "n": 30, "nField": "reported", "population": "adults with sacrococcygeal pilonidal sinus, including new and recurrent cases and some who previously had incision and drainage", "intervention": "Limberg flap rotation surgery", "comparator": "none (single group, no comparison treatment)", "primaryOutcome": "wound infection, pain, recurrence, and return to work after surgery", "result": "patients had minimal pain, averaged 5 days in hospital, returned to work after 3 weeks, a few had flap edema or necrosis needing 2-3 extra weeks to heal, and no recurrences so far", "resultDirection": "unclear", "quality": "low", "qualityWhy": "this was a small single-group study of only 30 patients with no comparison group, so it cannot show whether this surgery is better than other options.", "directness": "indirect", "limitations": "no control group, small sample size, surgery (flap) differs from simple incision and drainage, follow-up duration not clearly stated", "followUp": "", "plainFinding": "Back to work in three weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24426457/", "sourceText": "Sacrococcygeal pilonidal sinus (SC-PSD) is an acquired condition usually seen in young adults especially males. This prospective study has been performed to determine effects of the Limberg flap rotation surgery for sacrococcygeal pilonidal sinus, its feasibility to the patients, their compliance, and outcomes such as wound infection, postoperative pain relief, recurrence rates, and return to work. A total of 30 patients were operated by the same two surgeons from January 2009 to June 2011, including both primary and recurrent diseases, and patients with previous incision and drainage done for the pilonidal abscess. All patients successfully underwent surgery, with very minimal postoperative pain, stayed in hospital for average 5 days, returned to work after 3 weeks, with 3 patients having flap edema, 2 having flap necrosis, and no recurrences so far. Patients with flap edema and flap necrosis took 2-3 weeks to heal with regular dressing and antibiotic usage. Limberg flap for sacrococcygeal pilonidal sinus was found very useful and sound in terms of postoperative pain, infection rates, and early return to work with almost nil recurrences.", "provenance": [ { "field": "n", "quote": "A total of 30 patients were operated by the same two surgeons from January 2009 to June 2011" }, { "field": "population", "quote": "including both primary and recurrent diseases, and patients with previous incision and drainage done for the pilonidal abscess" }, { "field": "intervention", "quote": "the Limberg flap rotation surgery for sacrococcygeal pilonidal sinus" }, { "field": "comparator", "quote": "All patients successfully underwent surgery" }, { "field": "primaryOutcome", "quote": "outcomes such as wound infection, postoperative pain relief, recurrence rates, and return to work" }, { "field": "result", "quote": "All patients successfully underwent surgery, with very minimal postoperative pain, stayed in hospital for average 5 days, returned to work after 3 weeks, with 3 patients having flap edema, 2 having flap necrosis, and no recurrences so far." }, { "field": "result", "quote": "Patients with flap edema and flap necrosis took 2-3 weeks to heal with regular dressing and antibiotic usage." } ] }, { "id": "pmid:24239526", "pmid": "24239526", "doi": "10.1016/j.amjsurg.2013.07.038", "nctId": null, "pmcid": null, "title": "Pilonidal disease in a military population: how far have we really come?", "firstAuthor": "Fitzpatrick", "multipleAuthors": true, "journal": "Am J Surg", "year": 2014, "design": "retrospective", "n": 151, "nField": "reported", "population": "military patients with pilonidal disease", "intervention": "surgical treatment for pilonidal disease, including excision, excision with closure, and incision and drainage", "comparator": "different surgical methods compared to each other", "primaryOutcome": "recurrence and complications after surgery", "result": "27.2% recurrence and 34.4% complication rates overall; no recovery time reported", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a retrospective single-center study looking at recurrence and complication risk factors, not recovery time, and mixes different surgical methods together.", "directness": "indirect", "limitations": "Retrospective design, single institution, military population only, and the study does not specifically track or report time to recovery after drainage.", "followUp": "", "plainFinding": "No recovery time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/24239526/", "sourceText": "BACKGROUND: Pilonidal disease (PD) has a long connection with military personnel, even nicknamed \"jeep disease\" during World War II. The aim of this study was to identify factors associated with recurrence and complications after surgery in a military population. METHODS: A retrospective cohort analysis of operative therapy for PD at a single institution from 2005 to 2011 was conducted. Patient demographics, disease characteristics, and surgical methods were assessed for the primary outcomes of recurrence and morbidity. RESULTS: A total of 151 patients with PD were identified, who underwent excision (45.7%), excision with primary closure (29.8%), and incision and drainage (9.9%). Overall recurrence and morbidity rates were 27.2% and 34.4%, respectively. Black race, chronic disease, wound infection, and infection and drainage were associated with recurrence (P < .05), and excision with primary closure was associated with increased complications (P < .001). CONCLUSIONS: PD remains a significant source of morbidity and recurrence among military personnel. Certain patient-related and disease-related factors portend a worse prognosis, with black race and operative method the strongest predictors of outcomes.", "provenance": [ { "field": "n", "quote": "A total of 151 patients with PD were identified" }, { "field": "population", "quote": "Pilonidal disease (PD) has a long connection with military personnel" }, { "field": "intervention", "quote": "who underwent excision (45.7%), excision with primary closure (29.8%), and incision and drainage (9.9%)" }, { "field": "comparator", "quote": "Patient demographics, disease characteristics, and surgical methods were assessed for the primary outcomes of recurrence and morbidity" }, { "field": "primaryOutcome", "quote": "assessed for the primary outcomes of recurrence and morbidity" }, { "field": "result", "quote": "Overall recurrence and morbidity rates were 27.2% and 34.4%, respectively" } ] }, { "id": "pmid:23945113", "pmid": "23945113", "doi": "10.2478/pjs-2013-0056", "nctId": null, "pmcid": null, "title": "Portable VAC therapy improve the results of the treatment of the pilonidal sinus--randomized prospective study", "firstAuthor": "Banasiewicz", "multipleAuthors": true, "journal": "Pol Przegl Chir", "year": 2013, "design": "rct", "n": 19, "nField": "reported", "population": "men with pilonidal sinus undergoing surgical removal", "intervention": "vacuum-assisted closure (VAC) wound therapy after cyst removal", "comparator": "standard wound dressing after cyst removal", "primaryOutcome": "time to wound healing, time to recovery, and pain after surgery", "result": "wound healing time, recovery time, and pain on days 4-7 were reduced with VAC therapy compared to standard dressing", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a very small study with only 19 patients, all men, from one outpatient clinic.", "directness": "indirect", "limitations": "Very small sample size (9 vs 10 patients), all male, single outpatient setting.", "followUp": "", "plainFinding": "Faster healing, less pain with VAC.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23945113/", "sourceText": "UNLABELLED: Multiple therapeutic approaches of the treatment of pilonidal sinuses have been described in the literature, but there are still controversies and lack of standardization. Vacuum Assisted Closure (VAC) therapy has potential beneficial effect on the wound healing after the sinus resection. THE AIM OF THE STUDY: To analyze the results of VAC therapy in the treatment of pilonidal sinuses. MATERIAL AND METHODS: After randomization in the control group (9 men) the simple excision of the pilonidal cyst was performed with the standard wound dressing. In the VAC group (10 men) the same surgical procedure was performed, but after the excision the VAC dressing with mobile VAC Freedom device was used. Both groups were treated in an outpatient setting under local anesthesia. The wound size, time of surgery, time of wound healing time of recovery and pain after the surgery (VAS score) were compared. RESULTS: In VAC treated group the wound size and time of surgery were similar to control group. Time of wound healing, recovery and the pain after surgery in days 4-7 were reduced in comparison to the standard treated group. CONCLUSIONS: VAC therapy can be easily used in an outpatient setting, mobile device is highly accepted, operation of the equipment is simple. VAC therapy significantly decreases the time of wound healing and absenteeism from work as well as the postoperative late pain.", "provenance": [ { "field": "n", "quote": "the control group (9 men)" }, { "field": "n", "quote": "In the VAC group (10 men)" }, { "field": "population", "quote": "After randomization in the control group (9 men) the simple excision of the pilonidal cyst was performed" }, { "field": "intervention", "quote": "after the excision the VAC dressing with mobile VAC Freedom device was used" }, { "field": "comparator", "quote": "the simple excision of the pilonidal cyst was performed with the standard wound dressing" }, { "field": "primaryOutcome", "quote": "The wound size, time of surgery, time of wound healing time of recovery and pain after the surgery (VAS score) were compared" }, { "field": "result", "quote": "Time of wound healing, recovery and the pain after surgery in days 4-7 were reduced in comparison to the standard treated group." } ] }, { "id": "pmid:23932616", "pmid": "23932616", "doi": "10.1016/j.jpedsurg.2013.01.029", "nctId": null, "pmcid": null, "title": "Treatment of adolescent pilonidal disease with a new modification to the Limberg flap: symmetrically rotated rhomboid excision and lateralization of the Limberg flap technique", "firstAuthor": "Afşarlar", "multipleAuthors": true, "journal": "J Pediatr Surg", "year": 2013, "design": "case-series", "n": 15, "nField": "reported", "population": "adolescents with pilonidal cyst disease", "intervention": "modified Limberg flap surgery (symmetrically rotated rhomboid excision with lateralized flap)", "comparator": "none (single group, no comparison)", "primaryOutcome": "wound infection and recurrence after surgery, plus hospital stay and drainage duration", "result": "Median hospital stay was 5 days, median drainage duration was 4 days, and no wound infection or recurrence occurred during follow-up", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "Only 15 patients were studied, there was no comparison group, and follow-up was short.", "directness": "indirect", "limitations": "Small number of patients and short follow-up period, as acknowledged by the authors; this describes a specific flap surgery, not simple incision and drainage.", "followUp": "4 months", "plainFinding": "About 5 days in hospital after flap surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23932616/", "sourceText": "BACKGROUND/PURPOSE: Pilonidal disease is a common and frustrating problem among adolescents due to its high recurrence rate. The rhomboid excision and Limberg flap techniques promise successful results, but the lower part of the incision left on the intergluteal sulcus is prone to recurrences. Consequently, we have developed a new modification to this technique and have designed a descriptive prospective study to evaluate its efficiency. METHODS: We conducted this prospective study between March 2011 and March 2012. All of the patients who were operated on for sacrococcygeal pilonidal disease were included in this study. The surgical procedure primarily consisted of symmetrically rotated (clockwise) rhomboid excision and lateralization of the Limberg flap in order to keep the inferior corner of the suture line apart from the intergluteal sulcus. RESULTS: A total of 15 adolescents (8 boys and 7 girls) were included in the study group. Of the patients, 47% were normal, 13% were overweight, and 40% were obese. Five patients were operated on under general anesthesia, and 10 were operated on under spinal anesthesia. The length of the flap margins ranged from 2.5 to 7 cm (median=4 cm). The median duration of hospitalization was 5 days, and the median duration of suction drainage was 4 days. The median postoperative follow-up period was 4 months (ranging from 1 to 12 months), and we did not encounter any wound infection or recurrent disease during this period. Only one patient had wound hematoma as a result of drain breakdown and was treated with wound care without any additional complications. CONCLUSION: Although the number of patients in this study was small and the follow-up period was short, we obtained satisfactory results without any recurrence by performing a symmetrically rotated rhomboid excision and lateralized Limberg flap procedure.", "provenance": [ { "field": "n", "quote": "A total of 15 adolescents (8 boys and 7 girls) were included in the study group." }, { "field": "population", "quote": "Pilonidal disease is a common and frustrating problem among adolescents" }, { "field": "intervention", "quote": "symmetrically rotated (clockwise) rhomboid excision and lateralization of the Limberg flap" }, { "field": "comparator", "quote": "descriptive prospective study to evaluate its efficiency" }, { "field": "primaryOutcome", "quote": "we did not encounter any wound infection or recurrent disease during this period" }, { "field": "result", "quote": "The median duration of hospitalization was 5 days, and the median duration of suction drainage was 4 days." }, { "field": "followUp", "quote": "The median postoperative follow-up period was 4 months (ranging from 1 to 12 months)" } ] }, { "id": "pmid:23373363", "pmid": "23373363", "doi": null, "nctId": null, "pmcid": null, "title": "Minor vs complete excision of pilonidal sinus--early postoperative period", "firstAuthor": "Petrović", "multipleAuthors": true, "journal": "Acta Chir Iugosl", "year": 2012, "design": "retrospective", "n": 127, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "minor (less extensive) excision of the pilonidal sinus", "comparator": "complete (midline) excision or marsupialisation", "primaryOutcome": "time to heal and return to daily activities after surgery", "result": "patients who had the less extensive excision healed in 2 to 5 weeks and returned to daily activities within 5 days, compared with 4 to 21 weeks healing time for midline excision/marsupialisation", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small, non-randomized comparison of two different time periods with short follow-up, so the results may not be reliable.", "directness": "direct", "limitations": "No randomization, different time periods compared, small numbers in the minor excision group, short follow-up (11.11 months) for recurrence.", "followUp": "11.11 months", "plainFinding": "Smaller excision healed faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/23373363/", "sourceText": "Pilonidal sinus arises in the natal cleft of the sacrococcigeal region either as a cyst or as an abscess collection containing hair. It is predominantly a condition of younger people. When presenting as an abscess it usually requires surgical incision and drainage, or bursts spontaneously. In general, there are various surgical approaches to this condition, from very simple to complex ones. Each technique has its supporters and justifications. In the 3 years period, from 2009-2011, 110 treatments of the pilonidal disease were performed on our department. Midline excision was performed in 75 (68.18%) patients and the rest had marsupielisation done. The average discharge time was 1.14 days. Failure to heal occurred in 15 patients (13.63%). During that period we saw recurrence in 4 patients (3.63%). All the patients were coming to our department for postoperative care. The shortest healing time was 4 weeks and longest 21 weeks. During the period may 2011-May 2012 we performed 17 less extensive excisions. All the patients were discharged from the clinic within 23 hours and returned to their daily activities within 5 days. Healing time varied from 2 weeks to 5 weeks. In only one patient with the extensive excision healing time was 8 weeks. Although we had a short follow up period of 11.11 months, we saw no recurrence yet. Our results show that simple individual approach to every patients gives fastest and most comfortable results.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus arises in the natal cleft of the sacrococcigeal region either as a cyst or as an abscess collection containing hair." }, { "field": "intervention", "quote": "During the period may 2011-May 2012 we performed 17 less extensive excisions." }, { "field": "comparator", "quote": "Midline excision was performed in 75 (68.18%) patients and the rest had marsupielisation done." }, { "field": "primaryOutcome", "quote": "The shortest healing time was 4 weeks and longest 21 weeks." }, { "field": "result", "quote": "All the patients were discharged from the clinic within 23 hours and returned to their daily activities within 5 days. Healing time varied from 2 weeks to 5 weeks." }, { "field": "n", "quote": "In the 3 years period, from 2009-2011, 110 treatments of the pilonidal disease were performed on our department." }, { "field": "n", "quote": "During the period may 2011-May 2012 we performed 17 less extensive excisions." } ] }, { "id": "pmid:22783986", "pmid": "22783986", "doi": "10.3109/14653249.2012.697147", "nctId": null, "pmcid": null, "title": "A short course of granulocyte-colony-stimulating factor to accelerate wound repair in patients undergoing surgery for sacrococcygeal pilonidal cyst: proof of concept", "firstAuthor": "Baldelli", "multipleAuthors": true, "journal": "Cytotherapy", "year": 2012, "design": "prospective-cohort", "n": 8, "nField": "reported", "population": "patients with complex sacrococcygeal pilonidal cysts undergoing surgery", "intervention": "G-CSF injections (a drug to boost stem cells) plus surgery to remove the cyst", "comparator": "surgery alone without G-CSF (control group)", "primaryOutcome": "time to complete wound healing after surgery", "result": "median time to complete healing was 117 days with G-CSF versus 145 days in controls, a significant difference", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a very small, non-randomized study of only 8 treated patients compared with a separate control group, so the results are not very reliable.", "directness": "indirect", "limitations": "Very small sample size (8 patients), non-randomized comparison with a control group, proof-of-concept design", "followUp": "until complete wound resolution (110-168 days)", "plainFinding": "Faster healing with added drug.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22783986/", "sourceText": "BACKGROUND AIMS: Stem cells, namely easily accessible bone marrow-derived cells (BMC), are reportedly capable of tissue repair in different damaged organs and might favor wound healing. The present study was undertaken to evaluate the feasibility and safety of BMC mobilization induced by granulocyte-colony-stimulating factor (G-CSF) in patients undergoing surgery for sacrococcygeal pilonidal cysts (SPC). To evaluate the possible clinical benefit of G-CSF in reducing the time to complete resolution, a comparison with a control group receiving surgery without G-CSF was performed. METHODS: Eight patients with complex SPC were included in this prospective trial. Patients were treated with G-CSF (5 µg/kg b.i.d.) for 3 consecutive days; standard surgical exeresis of the pilonidal cyst was scheduled on day 2 of mobilization. Mobilization was assessed in terms of circulating CD34(+) cells and granulocyte-macrophage colony-forming unit (CFU-GM) progenitors. RESULTS: Mobilization of CD34(+) cells and CFU-GM occurred in all patients, along with a marked increase in white blood cells (median peak value 28 435/µL, day 3). G-CSF was well tolerated and no adverse events occurred. All patients received the planned surgical treatment without any complications. Interestingly, the G-CSF group patients had a median time to resolution (117 days, range 110-130) significantly shorter than control patients (145 days, range 118-168) (P = 0.034). CONCLUSIONS: G-CSF administration, along with BMC mobilization, is feasible and well tolerated in patients undergoing surgery for SPC; clinical results compare favorably with those observed in controls not receiving G-CSF; the results suggest the potential use of G-CSF as an additional treatment to accelerate wound healing in patients undergoing surgery.", "provenance": [ { "field": "n", "quote": "Eight patients with complex SPC were included in this prospective trial." }, { "field": "population", "quote": "patients undergoing surgery for sacrococcygeal pilonidal cysts (SPC)" }, { "field": "intervention", "quote": "Patients were treated with G-CSF (5 µg/kg b.i.d.) for 3 consecutive days; standard surgical exeresis of the pilonidal cyst was scheduled on day 2 of mobilization." }, { "field": "comparator", "quote": "a comparison with a control group receiving surgery without G-CSF was performed" }, { "field": "primaryOutcome", "quote": "time to complete resolution" }, { "field": "result", "quote": "the G-CSF group patients had a median time to resolution (117 days, range 110-130) significantly shorter than control patients (145 days, range 118-168) (P = 0.034)" } ] }, { "id": "pmid:22595842", "pmid": "22595842", "doi": "10.1097/DCR.0b013e31824b9527", "nctId": null, "pmcid": null, "title": "Converting emergency pilonidal abscess into an elective procedure", "firstAuthor": "Hussain", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2012, "design": "prospective-cohort", "n": 40, "nField": "reported", "population": "adults who came to the hospital with an acute pilonidal abscess", "intervention": "needle aspiration of the abscess under local anesthetic plus oral antibiotics", "comparator": "traditional incision and drainage (implied by contrast, not directly tested)", "primaryOutcome": "number of days to return to normal activities, response to treatment, and leftover inflammation", "result": "38 of 40 patients had the infection clear up and were back to normal activities the next day, with definitive surgery done later at a median of 9 weeks", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it was a small, single-center study with no comparison group, so it can't prove this approach is better than standard drainage.", "directness": "direct", "limitations": "no control group, single center, and some patients had not yet completed definitive surgery at the time of reporting", "followUp": "", "plainFinding": "Fast recovery after simple drainage.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22595842/", "sourceText": "BACKGROUND: Improvements in outcome after surgery for elective pilonidal sinus disease have yet to be matched for those presenting with acute disease. Traditional approaches to the management of acute pilonidal abscess have been associated with slow healing and significant loss of working time. OBJECTIVE: The aim of this study was to report our approach in which a temporizing intervention allows subsequent definitive treatment with low morbidity. DESIGN: This article presents a prospective cohort study. SETTING: This study was performed in acute admissions to the Surgical Unit in York Teaching Hospital. PATIENTS: Patients presenting with acute pilonidal abscess, not septic, immune-compromised, or diabetic, and without skin necrosis, underwent aspiration on the surgical ward. INTERVENTION: Aspiration of pilonidal abscess under local anesthetic was performed with the use of a wide-bore needle. The abscess cavity was drained to dryness, samples were sent to the laboratory for microbiology, and empirical oral antibiotics were commenced, covering anaerobes and aerobes. Review was arranged for within 7 days to plan elective excision and primary closure of the underlying pilonidal sinus. MAIN OUTCOME MEASURES: The primary outcomes measured were the number of days required to return to normal activities, response to treatment, and any residual inflammation. RESULTS: Fifty-six patients were referred with acute pilonidal abscess. Forty patients met the criteria for aspiration and empirical antibiotic treatment. All were allowed to go home the same day and were reviewed within a median of 5 days. Thirty-eight (38/40) patients demonstrated complete resolution of acute inflammation and were back to normal activities the following day. Fifteen patients subsequently underwent day-case excision and primary closure at a median of 9 weeks. Another 13 are awaiting surgery, and 10 patients have declined further treatment. Two (2/40) patients did not respond, one of whom did not receive the appropriate antibiotics. Both were managed with incision and drainage. CONCLUSIONS: Aspiration and antibiotic management of pilonidal abscess is effective in 95% of acute cases in preventing the need for emergent laying open and allows for subsequent elective surgery.", "provenance": [ { "field": "n", "quote": "Forty patients met the criteria for aspiration and empirical antibiotic treatment." }, { "field": "population", "quote": "Patients presenting with acute pilonidal abscess, not septic, immune-compromised, or diabetic, and without skin necrosis, underwent aspiration on the surgical ward." }, { "field": "intervention", "quote": "Aspiration of pilonidal abscess under local anesthetic was performed with the use of a wide-bore needle." }, { "field": "comparator", "quote": "Traditional approaches to the management of acute pilonidal abscess have been associated with slow healing and significant loss of working time." }, { "field": "primaryOutcome", "quote": "The primary outcomes measured were the number of days required to return to normal activities, response to treatment, and any residual inflammation." }, { "field": "result", "quote": "Thirty-eight (38/40) patients demonstrated complete resolution of acute inflammation and were back to normal activities the following day. Fifteen patients subsequently underwent day-case excision and primary closure at a median of 9 weeks." } ] }, { "id": "pmid:22033544", "pmid": "22033544", "doi": "10.1007/s10151-011-0782-5", "nctId": null, "pmcid": null, "title": "The effects of drainage on the rates of early wound complications and recurrences after Limberg flap reconstruction in patients with pilonidal disease", "firstAuthor": "Kirkil", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2011, "design": "rct", "n": 60, "nField": "reported", "population": "people with pilonidal cysts having Limberg flap surgery", "intervention": "leaving a drain in the wound cavity after flap surgery", "comparator": "no drain after flap surgery", "primaryOutcome": "wound complications and cyst coming back", "result": "similar rates of wound problems and recurrence whether or not a drain was used", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "it was a randomized trial but very small and looked at flap surgery drains, not simple cyst drainage or recovery time", "directness": "indirect", "limitations": "small sample size, some patients lost to follow-up, and it studied a specific surgical technique rather than simple cyst drainage", "followUp": "", "plainFinding": "Drain use didn't change healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/22033544/", "sourceText": "BACKGROUND: Cavity drainage has been used routinely in Limberg flap repair for pilonidal disease but there have been few controlled studies on the rationale for routine usage of drains. The aim of this study was to determine whether routine cavity drainage affects the rates of early wound complications and recurrences after rhomboid excision with Limberg flap repair for pilonidal disease. METHODS: Sixty patients with pilonidal disease in the sacrococcygeal region were randomized sequentially into 2 groups as drained or non-drained. All of them underwent rhomboid excision and Limberg flap reconstruction. The patients were followed up by physical examination at 2 and 4 weeks after the operation and every 6 months thereafter. RESULTS: Two patients in the drained group and 3 patients in the non-drained group were excluded from the study because of non-attendance at the follow-up physical examinations. The average length of hospital stay was 3.1 ± 0.9 and 3.3 ± 0.8 days in the drained and non-drained groups, respectively. There were 5 seromas, 2 wound dehiscences and 1 hematoma in the non-drained group, while 3 seromas and 2 wound dehiscences developed in the drained group. The complication rates of groups were similar (29.6% in the non-drained group vs. 17.8% in the drained group). Pilonidal disease recurred in 2 patients in the drained group who had wound dehiscence and in 3 patients in the non-drained group who had wound dehiscence or seroma. CONCLUSIONS: Routine usage of drains for Limberg flap reconstruction in the sacrococcygeal region did not affect wound-related complications and recurrence rates.", "provenance": [ { "field": "n", "quote": "Sixty patients with pilonidal disease in the sacrococcygeal region were randomized sequentially into 2 groups as drained or non-drained." }, { "field": "population", "quote": "patients with pilonidal disease" }, { "field": "intervention", "quote": "Cavity drainage has been used routinely in Limberg flap repair for pilonidal disease" }, { "field": "comparator", "quote": "randomized sequentially into 2 groups as drained or non-drained" }, { "field": "primaryOutcome", "quote": "determine whether routine cavity drainage affects the rates of early wound complications and recurrences after rhomboid excision with Limberg flap repair for pilonidal disease" }, { "field": "result", "quote": "Routine usage of drains for Limberg flap reconstruction in the sacrococcygeal region did not affect wound-related complications and recurrence rates." } ] }, { "id": "pmid:21911239", "pmid": "21911239", "doi": "10.1016/j.surg.2011.06.019", "nctId": null, "pmcid": null, "title": "Sinusectomy for primary pilonidal sinus: less is more", "firstAuthor": "Soll", "multipleAuthors": true, "journal": "Surgery", "year": 2011, "design": "retrospective", "n": 257, "nField": "reported", "population": "patients operated on for pilonidal sinus", "intervention": "sinusectomy (minimally invasive removal of the sinus track)", "comparator": "no control group; outcomes compared between local vs general anesthesia and outpatient vs inpatient setting", "primaryOutcome": "return of the sinus (recurrence) and time off work", "result": "7% of patients had the sinus come back, and people returned to work after a median of 7 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a retrospective study without a comparison group, relying partly on patient questionnaires and phone surveys, so results could be biased.", "directness": "indirect", "limitations": "Retrospective data collection using questionnaires and telephone survey; no control group for comparison.", "followUp": "3.6 years", "plainFinding": "Back to work within about a week.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21911239/", "sourceText": "BACKGROUND: Wide excision with secondary wound healing is a frequently performed surgical procedure for pilonidal sinus. This intervention requires general anesthesia and has a wound healing time of up to several months with a long time to return to work. Sinusectomy of the track is an alternative operation. We here describe the long-term outcome of 257 patients operated between 2001 and 2010. METHODS: Sinusectomy consisted of a selective minimal invasive excision of the sinus after marking the track with methylene blue. Data were collected retrospectively with questionnaires and telephone survey. The main endpoints of the study were recurrence and time off work. RESULTS: With a median follow-up of 3.6 years, the overall recurrence rate was 7%. The median time to return to work was 7 days. The proportion of sinusectomies performed under local anesthesia increased from 59% to 93%. Consistently, the proportion of patients treated in 1-day surgery setting increased from 53% to 93%. One-day surgery had a clear impact on time to return to work in uni- and multivariate analyses (HR 1.959 {1.224, 3.137}, P = .005). CONCLUSION: Sinusectomy for pilonidal sinus can be performed with a low recurrence rate. An outpatient setting, including operations under local anesthesia, allows a fast return to normal activity. Sinusectomy should become the first choice for primary non-infected symptomatic pilonidal sinus.", "provenance": [ { "field": "n", "quote": "long-term outcome of 257 patients operated between 2001 and 2010" }, { "field": "population", "quote": "Wide excision with secondary wound healing is a frequently performed surgical procedure for pilonidal sinus." }, { "field": "intervention", "quote": "Sinusectomy consisted of a selective minimal invasive excision of the sinus after marking the track with methylene blue." }, { "field": "comparator", "quote": "The proportion of sinusectomies performed under local anesthesia increased from 59% to 93%." }, { "field": "primaryOutcome", "quote": "The main endpoints of the study were recurrence and time off work." }, { "field": "result", "quote": "the overall recurrence rate was 7%. The median time to return to work was 7 days." }, { "field": "followUp", "quote": "median follow-up of 3.6 years" } ] }, { "id": "pmid:21727876", "pmid": "21727876", "doi": "10.12968/jowc.2011.20.6.275", "nctId": null, "pmcid": null, "title": "The use of acellular dermal regeneration template for recalcitrant pilonidal disease", "firstAuthor": "Vaughn", "multipleAuthors": true, "journal": "J Wound Care", "year": 2011, "design": "case-series", "n": 2, "nField": "reported", "population": "patients with chronic, recurring pilonidal sinus disease", "intervention": "wide surgical removal of the cyst plus placement of a dermal regeneration scaffold (Integra) and negative pressure wound therapy", "comparator": "no comparison group", "primaryOutcome": "wound healing and whether the disease came back", "result": "both patients healed completely and did not need further surgery after a median follow-up of 29 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a report on only two patients with no comparison group, so it cannot show what normally happens after simple drainage.", "directness": "indirect", "limitations": "only two patients, no control group, and the abstract itself says more research and longer follow-up are needed.", "followUp": "29 months", "plainFinding": "Both healed, no recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21727876/", "sourceText": "Numerous techniques have been described for the treatment of pilonidal disease, yet there remains no consensus on the optimal management of recurrent pilonidal disease. Pilonidal wounds often lack the structural integrity to heal over and Integra provides a scaffold for the regrowth of an autogenous dermis from the patient's own fibroblasts and collagen. Postoperative negative pressure wound therapy (NPWT) may speed vascularisation of Integra, re-epithelialisation, and wound closure. This case report concerns two patients with chronic pilonidal sinuses who underwent wide excision and placement of Integra with postoperative NPWT. Postoperatively, the patients were assessed for complications and recurrence. Both patients went on to heal and did not require further surgical treatment after a median follow-up of 29 months. Integra may help prevent pocket or cyst formation during the closure process and provides a neodermis, allowing for full re-epithelialisation. More research and a longer follow-up are needed to evaluate the role of Integra and NPWT in recurrent pilonidal disease.", "provenance": [ { "field": "n", "quote": "This case report concerns two patients with chronic pilonidal sinuses" }, { "field": "population", "quote": "two patients with chronic pilonidal sinuses" }, { "field": "intervention", "quote": "underwent wide excision and placement of Integra with postoperative NPWT" }, { "field": "comparator", "quote": "This case report concerns two patients with chronic pilonidal sinuses who underwent wide excision and placement of Integra with postoperative NPWT." }, { "field": "primaryOutcome", "quote": "the patients were assessed for complications and recurrence" }, { "field": "result", "quote": "Both patients went on to heal and did not require further surgical treatment after a median follow-up of 29 months." } ] }, { "id": "pmid:21573899", "pmid": "21573899", "doi": "10.1007/s00384-011-1242-4", "nctId": null, "pmcid": null, "title": "Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients", "firstAuthor": "Milone", "multipleAuthors": true, "journal": "Int J Colorectal Dis", "year": 2011, "design": "rct", "n": 803, "nField": "reported", "population": "adults having surgery for a pilonidal sinus at the base of the spine", "intervention": "placing a drain in the wound after surgical removal and closure", "comparator": "no drain, just surgical removal and closure", "primaryOutcome": "time off work, time to walk without pain, and time to sit on the toilet without pain after surgery", "result": "no significant difference between drained and non-drained wounds in time off work, time to pain-free walking, or time to pain-free sitting, though pain scores were slightly lower with a drain", "resultDirection": "no-benefit", "quality": "moderate", "qualityWhy": "large randomized trial with clear outcomes, but it studies drain use after excision surgery rather than simple cyst drainage, so it doesn't directly answer recovery time after drainage alone", "directness": "indirect", "limitations": "abstract does not report loss to follow-up, blinding, or exact numeric recovery times", "followUp": "", "plainFinding": "No difference in recovery time.", "retracted": false, "expressionOfConcern": false, "hasErratum": true, "url": "https://pubmed.ncbi.nlm.nih.gov/21573899/", "sourceText": "PURPOSE: The aim of this study was to evaluate the influence of cavity drainage in the surgical treatment of sacrococcygeal pilonidal sinuses. METHODS: The study was prospectively carried out in 803 patients randomized into two groups of respectively 401 and 402 patients. In the first group, primary excision and closure were associated with drainage of the wound; in the second group, the wound was not drained. We have analyzed time off work, time to walk without pain, time to sitting on the toilet without pain, recurrences, and wound infections. We have also evaluated the satisfaction rate and esthetic results. RESULTS: On comparing time off work, time to walk without pain, and time to sitting on toilet without pain postoperatively, there were no significant differences between the two groups. A significant difference between the two groups with regard to wound infection rates (p = 0.5) and recurrence rates (p = 0.6) was not observed. In order to prevent prolonged inpatient stay and social intolerance, this study suggests that the post-operative period is tolerated by a few when a drain was used. The visual analog scale (VAS) in the drained group was 3.2 ± 0.9, and VAS in the non-drained group was 3.5 ± 0.9 with a significant statistical difference (p = 0.0001). As regards the cosmetic appearance of the scar after surgery, we achieved a high satisfaction rate among patients in either group with 82.9% good cosmetic results. CONCLUSIONS: The use of a drain, in our experience, appears to be useless in achieving a quick healing of the sacral wound; in addition, it has a low satisfaction rate.", "provenance": [ { "field": "n", "quote": "803 patients randomized into two groups of respectively 401 and 402 patients" }, { "field": "population", "quote": "surgical treatment of sacrococcygeal pilonidal sinuses" }, { "field": "intervention", "quote": "primary excision and closure were associated with drainage of the wound" }, { "field": "comparator", "quote": "the wound was not drained" }, { "field": "primaryOutcome", "quote": "time off work, time to walk without pain, time to sitting on the toilet without pain, recurrences, and wound infections" }, { "field": "result", "quote": "there were no significant differences between the two groups" } ] }, { "id": "pmid:21533783", "pmid": "21533783", "doi": "10.1007/s10151-011-0684-6", "nctId": null, "pmcid": null, "title": "Does pilonidal abscess heal quicker with off-midline incision and drainage?", "firstAuthor": "Webb", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2011, "design": "retrospective", "n": 243, "nField": "reported", "population": "adults who had a pilonidal abscess drained in hospital", "intervention": "draining the abscess through a cut to the side of the midline (lateral incision)", "comparator": "draining the abscess through a cut along the midline", "primaryOutcome": "how long the wound took to heal", "result": "abscesses drained off the midline healed about three weeks faster than those drained through a midline incision", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it was a retrospective, non-randomised review of hospital records with a small matched subgroup, so it can't reliably prove cause and effect.", "directness": "direct", "limitations": "retrospective study that did not capture patients whose abscess drained spontaneously or were drained in the emergency department", "followUp": "", "plainFinding": "Off-midline drainage heals about 3 weeks faster.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21533783/", "sourceText": "BACKGROUND: No clinical trials have been done to guide the surgeon in the optimal technique of draining a pilonidal abscess. The aim of our study was to investigate whether the location of the incision influences wound healing. METHODS: Electronic records from the surgical database at our 200-bed district general hospital were reviewed for operative technique (midline vs. lateral) for patients who underwent incision and drainage for acute pilonidal abscess between January 2003 and February 2010. These patients were admitted from the Emergency Department with a pilonidal abscess, underwent operative drainage, and returned for follow-up. The main outcome measure was wound healing time. RESULTS: Two hundred and forty-three pilonidal abscesses were drained, 134 with a lateral and 74 with a midline incision. All patients underwent simple longitudinal incision. No patient underwent de-roofing, marsupialisation, or closure. Forty-eight patients with midline drainage who returned for follow-up were matched for gender, age, and microbiology culture results with patients who underwent lateral drainage. Almost all were drained under general anesthesia with a median postoperative stay of 1 day. The overall length of follow-up was the same in both groups (P = 0.13). Abscesses that did not heal were followed-up for the same period of time irrespective of incision type (P = 0.48). Abscesses that healed after midline incision took approximately 3 weeks longer than those drained via a lateral incision (P = 0.02). Our study has limitations since it was a retrospective study that did not capture patients whose abscess drained spontaneously or were drained in the emergency department. CONCLUSIONS: Pilonidal abscess should be drained away from the midline.", "provenance": [ { "field": "n", "quote": "Two hundred and forty-three pilonidal abscesses were drained" }, { "field": "population", "quote": "patients who underwent incision and drainage for acute pilonidal abscess between January 2003 and February 2010" }, { "field": "intervention", "quote": "lateral incision" }, { "field": "comparator", "quote": "midline incision" }, { "field": "primaryOutcome", "quote": "The main outcome measure was wound healing time." }, { "field": "result", "quote": "Abscesses that healed after midline incision took approximately 3 weeks longer than those drained via a lateral incision (P = 0.02)." } ] }, { "id": "pmid:21251431", "pmid": "21251431", "doi": "10.1503/cjs.028509", "nctId": null, "pmcid": "PMC3038365", "title": "A pediatric surgeon's 35-year experience with pilonidal disease in a Canadian children's hospital", "firstAuthor": "Nasr", "multipleAuthors": true, "journal": "Can J Surg", "year": 2011, "design": "retrospective", "n": 121, "nField": "reported", "population": "teenagers and young adults with pilonidal cysts (ages 12-19) treated at a children's hospital", "intervention": "surgical removal of the cyst, either packed open, marsupialized, or stitched closed without drainage", "comparator": "comparing the three different surgical approaches to each other", "primaryOutcome": "how long the wound took to heal and whether the cyst came back", "result": "wounds that were cut open and packed took about 75 days to heal, at least twice as long as the other two methods, but the chance of the cyst coming back was similar across all methods (about 22%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a retrospective chart review of one surgeon's cases over decades, with the operation chosen arbitrarily rather than by a controlled method, so bias is likely.", "directness": "indirect", "limitations": "retrospective design, single surgeon, pediatric population only, operation type was arbitrarily chosen rather than randomized", "followUp": "", "plainFinding": "Packing wounds open healed much slower.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21251431/", "sourceText": "BACKGROUND: There is an ongoing debate regarding the optimal surgical management for pilonidal disease in the pediatric population. The purpose of this study was to evaluate a pediatric surgeon's experience at a Canadian children's hospital over 35 years. METHODS: We performed a retrospective review of the charts of patients seen and treated from July 1969 to December 2003, inclusive. All patients were evaluated for age, sex, clinical diagnosis, infection, treatment, healing time, complications and results. RESULTS: In all, 121 adolescents with pilonidal disease (64 boys, 57 girls) with a mean age of 15 (range 12-19) years were evaluated at the same children's hospital. The 107 (88%) patients with infection (46% acute) underwent surgery. At operation, all 107 pilonidal cysts were either excised and packed open, marsupialized or excised and closed primarily without drainage under general anesthesia; the operation performed was arbitrarily chosen. Vacuum-assisted closure was not used. All patients received antibiotics. The time for healing after the initial operation in the group whose cysts were excised and packed open was at least twice as long (75 d) as in the other 2 groups (p = 0.031). Disease recurred in 24 (22%) patients, 6 (25%) of whom experienced 2 recurrences. Among the 90 patients in the excised and packed open group, 20 (22%) experienced recurrences and 5 (25%) experienced 2 recurrences. Among the 13 patients in the marsupialized group, 3 (23%) experienced recurrences and 1 (33%) experienced 2 recurrences. Among the 4 patients in the excised and closed primarily without drainage group, 1 (25%) experienced a recurrence and none experienced 2 recurrences (p = 0.12). Each recurrence was smaller than the original. All wounds eventually healed. There were no other complications and no deaths. A multivariable logistic regression analysis revealed that the type of surgical approach was not predictive of recurrence after controlling for age and sex. CONCLUSION: Age, sex and surgical approach were not predictive of recurrence. From our experience, excision and packing open the wound produced a longer morbidity but offered the same results compared with marsupialization or excision and primary closure without drainage.", "provenance": [ { "field": "n", "quote": "121 adolescents with pilonidal disease (64 boys, 57 girls) with a mean age of 15 (range 12-19) years were evaluated" }, { "field": "population", "quote": "121 adolescents with pilonidal disease (64 boys, 57 girls) with a mean age of 15 (range 12-19) years were evaluated at the same children's hospital" }, { "field": "intervention", "quote": "all 107 pilonidal cysts were either excised and packed open, marsupialized or excised and closed primarily without drainage under general anesthesia; the operation performed was arbitrarily chosen" }, { "field": "comparator", "quote": "The time for healing after the initial operation in the group whose cysts were excised and packed open was at least twice as long (75 d) as in the other 2 groups (p = 0.031)." }, { "field": "primaryOutcome", "quote": "All patients were evaluated for age, sex, clinical diagnosis, infection, treatment, healing time, complications and results." }, { "field": "result", "quote": "The time for healing after the initial operation in the group whose cysts were excised and packed open was at least twice as long (75 d) as in the other 2 groups (p = 0.031). Disease recurred in 24 (22%) patients, 6 (25%) of whom experienced 2 recurrences." } ] }, { "id": "pmid:21125608", "pmid": "21125608", "doi": "10.1002/bjs.7292", "nctId": null, "pmcid": null, "title": "Simple day-case surgery for pilonidal sinus disease", "firstAuthor": "Thompson", "multipleAuthors": true, "journal": "Br J Surg", "year": 2011, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "patients with pilonidal sinus disease", "intervention": "simple day-case surgery (removal of midline skin pits with lateral drainage of abscess/sinus)", "comparator": "wide excisional surgery and non-surgical/expectant treatment", "primaryOutcome": "return to work, healing and complications after treatment", "result": "more conservative, simple day-case procedures were associated with rapid return to work and fewer complications than wide excision", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a general literature review without systematic quality grading or pooled data, so it carries less weight than a controlled study.", "directness": "indirect", "limitations": "abstract does not describe specific recovery times, is a narrative synthesis of varied studies, and excludes papers on new or modified techniques", "followUp": "", "plainFinding": "Faster recovery with simple surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/21125608/", "sourceText": "BACKGROUND: Pilonidal disease is a common and usually minor disease. Although wide excisional surgery has been common practice, there are more simple alternatives. This review focused on the aetiology and management of pilonidal disease. METHODS: A comprehensive review of the literature on pilonidal disease was undertaken. MEDLINE searches for all articles listing pilonidal disease (1980-2010) were performed to determine the aetiology and results of surgical and non-surgical treatments. Single papers describing new techniques or minor modifications of established techniques were excluded. Further articles were traced through reference lists. RESULTS: Patients with minimal symptoms and those having drainage of a single acute abscess can be treated expectantly. Non-surgical treatments may be of value but their long-term results are unknown. There is no rational basis or need for wide excision of the abscess and sinus. Simple removal of midline skin pits, the primary cause of pilonidal disease, with lateral drainage of the abscess and sinus is effective in most instances. Hirsute patients with extensive primary disease and deep natal clefts, or with recurrent disease and unhealed midline wounds, may also require flattening of the natal cleft with off-midline skin closure. These more conservative procedures are usually done as a day case, require minimal care in the community and are associated with a rapid return to work. They also avoid the occasional debilitating complications of surgical treatment. CONCLUSION: Simple day-case surgery to eradicate midline skin pits without wide excision of the abscesses and sinus is rational, safe and effective for patients with pilonidal sinus disease.", "provenance": [ { "field": "population", "quote": "patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "Simple removal of midline skin pits, the primary cause of pilonidal disease, with lateral drainage of the abscess and sinus is effective in most instances." }, { "field": "comparator", "quote": "Although wide excisional surgery has been common practice, there are more simple alternatives." }, { "field": "primaryOutcome", "quote": "associated with a rapid return to work" }, { "field": "result", "quote": "These more conservative procedures are usually done as a day case, require minimal care in the community and are associated with a rapid return to work." } ] }, { "id": "pmid:20721696", "pmid": "20721696", "doi": "10.1007/s11845-010-0549-4", "nctId": null, "pmcid": null, "title": "Are postoperative drains necessary with the Karydakis flap for treatment of pilonidal sinus? (Can fibrin glue be replaced to drains?) A prospective randomized trial", "firstAuthor": "Sözen", "multipleAuthors": true, "journal": "Ir J Med Sci", "year": 2011, "design": "rct", "n": 50, "nField": "reported", "population": "male patients with pilonidal sinus who had Karydakis flap surgery", "intervention": "fibrin glue instead of a drain after surgery", "comparator": "suction drain after surgery", "primaryOutcome": "fluid buildup at the wound site and recurrence", "result": "fluid collection occurred more often with fibrin glue (24%) than with a suction drain (8%), and no patients had the cyst come back", "resultDirection": "mixed", "quality": "low", "qualityWhy": "small study of only 50 patients looking at a flap surgery technique, not at drainage of the cyst itself.", "directness": "indirect", "limitations": "small sample size, single surgical technique (Karydakis flap) rather than drainage, all male patients, follow-up duration not specified.", "followUp": "", "plainFinding": "More fluid buildup with glue, no recurrences.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20721696/", "sourceText": "PURPOSE: Different surgical techniques for pilonidal disease have been described in the literature. In this study, our aim was to evaluate the influence of routine cavity drainage in the Karydakis flap technique. METHODS: As much as 50 male patients with pilonidal sinus who underwent the Karydakis flap operation were evaluated prospectively.The patients were assigned randomly into two groups (Group 1 with suction drain; Group 2 fibrin glue). RESULTS: Fluid collection was encountered in 8 out of 50 patients (6.25%): 6 in Group 2 (24%) of which 4 experienced superficial, healed with simple dressing, the other 2 with substantial dehiscence healed with wound dressing; 2 in Group 1 (8%) were treated with wound punctures.There has been no recurrence in any of the patients during the follow-up period.The Karydakis flap operations can be performed with a near zero recurrence rate with the use of drains. CONCLUSION: We recommend the use of fibrin sealant with Karydakis flap procedure, but further studies are needed to confirm this conclusion.", "provenance": [ { "field": "population", "quote": "50 male patients with pilonidal sinus who underwent the Karydakis flap operation were evaluated prospectively" }, { "field": "intervention", "quote": "Group 2 fibrin glue" }, { "field": "comparator", "quote": "Group 1 with suction drain" }, { "field": "primaryOutcome", "quote": "our aim was to evaluate the influence of routine cavity drainage in the Karydakis flap technique" }, { "field": "result", "quote": "Fluid collection was encountered in 8 out of 50 patients (6.25%): 6 in Group 2 (24%) of which 4 experienced superficial, healed with simple dressing, the other 2 with substantial dehiscence healed with wound dressing; 2 in Group 1 (8%) were treated with wound punctures.There has been no recurrence in any of the patients during the follow-up period." }, { "field": "n", "quote": "50 male patients with pilonidal sinus who underwent the Karydakis flap operation were evaluated prospectively" } ] }, { "id": "pmid:20668329", "pmid": "20668329", "doi": null, "nctId": null, "pmcid": null, "title": "Tension-free primary closure with autologous platelet gel versus Vivostat- for the definitive treatment of chronic sacrococcygeal pilonidal disease", "firstAuthor": "Gipponi", "multipleAuthors": true, "journal": "In Vivo", "year": 2010, "design": "rct", "n": 100, "nField": "reported", "population": "adults with long-lasting or repeat pilonidal cysts at the base of the spine", "intervention": "wound closure after cyst removal using platelet gel made in the hospital", "comparator": "wound closure after cyst removal using platelet gel made by the Vivostat system", "primaryOutcome": "how long the wound took to heal and time to return to normal activity", "result": "the Vivostat gel group healed faster and had fewer wound problems than the in-house gel group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a randomized trial but it compares two surgical wound-sealant products after full cyst excision, not drainage, so it cannot answer how long recovery takes after simple drainage.", "directness": "indirect", "limitations": "compares two gel products after excisional surgery rather than studying drainage of an abscess, and does not describe blinding", "followUp": "median follow-up of 21 months (range: 4-40 months)", "plainFinding": "Faster healing with Vivostat gel.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20668329/", "sourceText": "OBJECTIVE: A randomized clinical trial was performed in patients with chronic or recurrent pilonidal sinus (PS) comparing primary closure coupled with random application of in house autologous platelet gel or produced by means of Vivostat- in order to assess whether a standardized product had an impact on the wound healing process. PATIENTS AND METHODS: Between June 2006 and June 2009, 100 patients (82 males, 18 females: median age 30 years; range, 16-51 years) underwent wide excision of the pilonidal area with midline tension-free closure and were randomly given either the in house autologous platelet gel (Group 1) or the Vivostat- gel (Group 2). RESULTS: Group 2 patients had shorter wound healing time (8 vs. 10 days; p<0.0001), time to return to full activity (11 vs. 16 days: p<0.0001), less uncomplicated fluid collections (120 vs. 190 ml: p<0.0001), and fewer postoperative wound complications (1/50=2% vs. 5/50=10%, p<0.001). After a median follow-up of 21 months (range: 4-40 months), two recurrences were detected in Group 1. CONCLUSION: The standardized production of platelet gel by means of the Vivostat- system guarantees the reproducibility of the procedure and its use was correlated with an improved outcome, with a high degree of patient satisfaction and better cosmetic results.", "provenance": [ { "field": "population", "quote": "patients with chronic or recurrent pilonidal sinus (PS)" }, { "field": "intervention", "quote": "randomly given either the in house autologous platelet gel (Group 1)" }, { "field": "comparator", "quote": "or the Vivostat- gel (Group 2)" }, { "field": "primaryOutcome", "quote": "Group 2 patients had shorter wound healing time (8 vs. 10 days; p<0.0001), time to return to full activity (11 vs. 16 days: p<0.0001)" }, { "field": "result", "quote": "Group 2 patients had shorter wound healing time (8 vs. 10 days; p<0.0001), time to return to full activity (11 vs. 16 days: p<0.0001), less uncomplicated fluid collections (120 vs. 190 ml: p<0.0001), and fewer postoperative wound complications (1/50=2% vs. 5/50=10%, p<0.001)" }, { "field": "n", "quote": "100 patients (82 males, 18 females: median age 30 years; range, 16-51 years)" } ] }, { "id": "pmid:20109636", "pmid": "20109636", "doi": "10.1016/j.suc.2009.09.006", "nctId": null, "pmcid": null, "title": "Evaluation and management of pilonidal disease", "firstAuthor": "Humphries", "multipleAuthors": true, "journal": "Surg Clin North Am", "year": 2010, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease", "intervention": "surgical treatment of pilonidal disease", "comparator": "nonoperative treatment options", "primaryOutcome": "wound healing and recovery after treatment", "result": "Not reported numerically; abstract states disease can involve significant morbidity and prolonged wound healing after definitive surgery", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a narrative review describing treatment options without presenting specific study data or outcomes measurements.", "directness": "indirect", "limitations": "The abstract does not report specific recovery times, patient numbers, or comparative results; it is a general review article.", "followUp": "", "plainFinding": "Recovery time not stated.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/20109636/", "sourceText": "Pilonidal disease is a common condition, ranging from the routine cyst with abscess to extensive chronic infection and sinus formation. It can be associated with significant morbidity and prolonged wound healing after definitive surgery. This article reviews the history and pathogenesis of this often challenging surgical problem and the numerous nonoperative and operative treatment options currently available for it.", "provenance": [ { "field": "population", "quote": "Pilonidal disease is a common condition, ranging from the routine cyst with abscess to extensive chronic infection and sinus formation." }, { "field": "intervention", "quote": "numerous nonoperative and operative treatment options currently available for it" }, { "field": "comparator", "quote": "numerous nonoperative and operative treatment options currently available for it" }, { "field": "primaryOutcome", "quote": "associated with significant morbidity and prolonged wound healing after definitive surgery" }, { "field": "result", "quote": "It can be associated with significant morbidity and prolonged wound healing after definitive surgery." } ] }, { "id": "pmid:19581864", "pmid": "19581864", "doi": "10.1007/DCR.0b013e31819ef582", "nctId": null, "pmcid": null, "title": "Management of pilonidal sinus disease with oblique excision and bilateral gluteus maximus fascia advancing flap: result of 278 patients", "firstAuthor": "Krand", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2009, "design": "case-series", "n": 278, "nField": "reported", "population": "people with pilonidal sinus disease without extensive gluteal involvement", "intervention": "oblique excision with bilateral gluteus maximus fascia advancing flap surgery", "comparator": "none - no comparison group", "primaryOutcome": "complications, recurrence, and time off work after surgery", "result": "average time off work was 12 days, complication rate 7.2%, recurrence rate 0.7%", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a case series with no comparison group, so we cannot tell if this technique is better than other options.", "directness": "indirect", "limitations": "No control group; abstract does not describe drainage (incision and drainage) specifically, only this flap surgery technique", "followUp": "66 +/- 32 months (range, 12 to 120)", "plainFinding": "Back to work in about 12 days", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19581864/", "sourceText": "PURPOSE: Excision followed by natal cleft depth reduction should be performed, with no leftover midline scar tissue, to prevent recurrence of pilonidal sinus, which is the main problem in the treatment of this disease. We investigated the potential advantages of this advancing flap technique, which we developed. METHOD: An S-type incision together with a bilateral gluteus maximus fascia advancing flap was applied on 278 (89 percent) patients, who did not have extensive gluteal involvement, of the 312 patients who had pilonidal sinus disease, between January 1997 and January 2007. No drainage was performed on any patient. RESULTS: All patients were discharged within 24 hours. Total complication rate was 7.2 percent and recurrence rate was 0.7 percent. The mean time off from work was 12 +/- 2 days (range, 10 to 22). The mean follow-up period was 66 +/- 32 months (range, 12 to 120). CONCLUSION: We suggest that this surgical procedure may successfully be applied to a large majority of the patients. It does not lead to unnecessary excision of healthy tissue because of its significantly simpler nature compared with the full-layer flap technique and its S-type incision, it does not create a midline scar tissue, and it is able to flatten the gluteal sulcus.", "provenance": [ { "field": "n", "quote": "was applied on 278 (89 percent) patients" }, { "field": "population", "quote": "patients, who did not have extensive gluteal involvement, of the 312 patients who had pilonidal sinus disease" }, { "field": "intervention", "quote": "An S-type incision together with a bilateral gluteus maximus fascia advancing flap was applied" }, { "field": "comparator", "quote": "No drainage was performed on any patient." }, { "field": "primaryOutcome", "quote": "Total complication rate was 7.2 percent and recurrence rate was 0.7 percent." }, { "field": "result", "quote": "The mean time off from work was 12 +/- 2 days (range, 10 to 22)." } ] }, { "id": "pmid:19394643", "pmid": "19394643", "doi": "10.1016/j.jss.2008.11.005", "nctId": null, "pmcid": null, "title": "A randomized clinical study evaluating the need for drainage after Limberg flap for pilonidal sinus", "firstAuthor": "Colak", "multipleAuthors": true, "journal": "J Surg Res", "year": 2010, "design": "rct", "n": 101, "nField": "reported", "population": "patients having surgery for pilonidal sinus (Limberg flap procedure)", "intervention": "no drain tube placed after flap surgery", "comparator": "drain tube placed after flap surgery", "primaryOutcome": "pain, analgesic use, hospital stay, complications, and recurrence after surgery", "result": "patients without a drain had less pain, needed less pain medicine, had fewer complications, and shorter hospital stays; recurrence rates were the same", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial but only looked at one surgical technique (flap repair) at a single center, not simple cyst drainage.", "directness": "indirect", "limitations": "studies a specific flap surgery (RELIF) with or without a drain tube, not simple incision and drainage of a pilonidal cyst/abscess", "followUp": "", "plainFinding": "Faster recovery without a drain.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/19394643/", "sourceText": "BACKGROUND: This prospective randomized clinical study was conducted to evaluate the need for drainage after rhomboid excision and a Limberg flap (RELIF) for the treatment of pilonidal sinus. METHODS: One hundred one patients undergoing the RELIF procedure were randomly treated with drainage or not. Operating time, postoperative pain assessed on a visual analogue scale (VAS), total amount of intramuscular analgesic administered, hospital stay, complications, recurrence rate, and patient satisfaction were assessed. RESULTS: The mean operating time (P = 0.036), VAS scores on postoperative day 0 (P = 0.039) and day 1 (P = 0.006), intramuscular analgesic requirement (P = 0.009), mean amount of intramuscular analgesic administered (P = 0.025), complication rate (P = 0.027), and mean hospital stay (P = 0.0001) were significantly reduced in the non-drained group. The recurrence rate was similar in the two groups (P = 0.32). CONCLUSIONS: This study indicates that drain placement after the RELIF procedure might negatively affect the postoperative outcomes of patients with pilonidal sinus. On the basis of these finding, we suggest that the use of drains may not be necessary after the RELIF procedure for the treatment of pilonidal sinus.", "provenance": [ { "field": "n", "quote": "One hundred one patients undergoing the RELIF procedure were randomly treated with drainage or not." }, { "field": "population", "quote": "patients with pilonidal sinus" }, { "field": "intervention", "quote": "randomly treated with drainage or not" }, { "field": "comparator", "quote": "randomly treated with drainage or not" }, { "field": "primaryOutcome", "quote": "Operating time, postoperative pain assessed on a visual analogue scale (VAS), total amount of intramuscular analgesic administered, hospital stay, complications, recurrence rate, and patient satisfaction were assessed." }, { "field": "result", "quote": "VAS scores on postoperative day 0 (P = 0.039) and day 1 (P = 0.006), intramuscular analgesic requirement (P = 0.009), mean amount of intramuscular analgesic administered (P = 0.025), complication rate (P = 0.027), and mean hospital stay (P = 0.0001) were significantly reduced in the non-drained group." } ] }, { "id": "pmid:18565338", "pmid": "18565338", "doi": "10.1016/j.amjsurg.2007.05.051", "nctId": null, "pmcid": null, "title": "Outcome of chronic pilonidal disease treatment after ambulatory plain midline excision and primary suture", "firstAuthor": "Tocchi", "multipleAuthors": true, "journal": "Am J Surg", "year": 2008, "design": "rct", "n": 103, "nField": "reported", "population": "patients with chronic, non-recurrent, quiet pilonidal sinus disease", "intervention": "surgical excision with primary closure plus wound drainage", "comparator": "surgical excision with primary closure without wound drainage", "primaryOutcome": "wound healing time and complications after surgery", "result": "Complete healing was fastest in patients in group A", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "It was a randomized trial but fairly small and only from one center, with healing time not given precisely.", "directness": "indirect", "limitations": "Abstract does not report blinding, exact healing times, or statistical significance values.", "followUp": "", "plainFinding": "Faster healing when wound drained.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18565338/", "sourceText": "BACKGROUND: Pilonidal sinus (PS) is a common chronic disorder of the sacrococcygeal region. The optimal treatment for PS remains controversial, and recent reports have advocated different surgical approaches. METHODS: A prospective study was performed on 103 patients with nonrecurrent quiescent chronic discharging sinus. Excision with primary closure was performed on all patients. Patients were subdivided randomly into 2 groups. In group A, the excision was associated with drainage of the wound; in group B, the wound was not drained. RESULTS: Excision with primary closure and drainage was performed in 53 patients (group A). Drainage was omitted in 50 patients (group B). Minor wound complications occurred in 3 patients in group A and in 36 patients in group B. No complete dehiscence of the wound was observed in patients in group A and in 8 patients in group B. Complete healing was fastest in patients in group A. Sinus recurrence occurred in 1 patient in group A and in 2 patients in group B. CONCLUSION: Short- and long-term results suggest that limited midline excision with primary closure and wound drainage is a simple and effective procedure in the surgical treatment of uncomplicated PS. More demanding flap techniques and plasties should be reserved for complicated PS, which requires a wider excision.", "provenance": [ { "field": "n", "quote": "A prospective study was performed on 103 patients with nonrecurrent quiescent chronic discharging sinus." }, { "field": "population", "quote": "103 patients with nonrecurrent quiescent chronic discharging sinus" }, { "field": "intervention", "quote": "the excision was associated with drainage of the wound" }, { "field": "comparator", "quote": "the wound was not drained" }, { "field": "primaryOutcome", "quote": "Complete healing was fastest in patients in group A." }, { "field": "result", "quote": "Complete healing was fastest in patients in group A." } ] }, { "id": "pmid:18513189", "pmid": "18513189", "doi": "10.1111/j.1463-1318.2008.01596.x", "nctId": null, "pmcid": null, "title": "Use of a double rhomboid transposition flap in the treatment of extensive complex pilonidal sinus disease", "firstAuthor": "El-Tawil", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2009, "design": "case-series", "n": 8, "nField": "reported", "population": "patients with extensive, recurrent, complex pilonidal sinus disease", "intervention": "double rhomboid transposition flap surgery to close the wound after removing the sinus", "comparator": "none (no comparison group)", "primaryOutcome": "time with drains in place, length of hospital stay, complications and recurrence", "result": "median drain time was 2 days and hospital stay was 2 days, with one wound infection and no recurrence over follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small uncontrolled case series of only 8 patients with no comparison group, so it gives limited confidence about typical recovery.", "directness": "indirect", "limitations": "very small sample, no control group, and this describes a complex reconstructive flap operation for large recurrent disease rather than simple drainage of a pilonidal cyst", "followUp": "33-month follow-up (range 8-41 months)", "plainFinding": "Quick recovery after flap surgery", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18513189/", "sourceText": "OBJECTIVE: Rhomboid transposition flaps are safe and successful in treating recurrent, complex pilonidal disease. There are little data on treatment of very large (> 12 cm) pilonidal sinuses. We describe a new technique using two simultaneous rhomboid flaps to achieve primary closure following extensive wide-excision. METHOD: With antibiotic prophylaxis, the sinus is excised en-bloc as a parallelogram (two adjacent rhomboids). Two rhomboid fasciocutaneous flaps are transposed to close this defect over suction-drains. Sutures are removed after 14 days. RESULTS: Eight patients (seven males) were treated with this technique (median age 26 years; range 22-35 years). All had very extensive and recurrent disease, having had multiple previous procedures. Median drain-duration was 2 days (range 1-5 days) and postoperative stay was 2 days (range 0-5 days). One complication arose: a wound infection with partial dehiscence which healed with conservative treatment. No recurrence or further complication arose in a 33-month follow-up (range 8-41 months). CONCLUSION: This is the first description of the use of two simultaneous rhomboid flaps for very large recurrent pilonidal disease. It is a relatively simple and safe alternative to major plastic reconstruction which is often resorted to in such large-scale disease.", "provenance": [ { "field": "n", "quote": "Eight patients (seven males) were treated with this technique" }, { "field": "population", "quote": "All had very extensive and recurrent disease, having had multiple previous procedures." }, { "field": "intervention", "quote": "Two rhomboid fasciocutaneous flaps are transposed to close this defect over suction-drains." }, { "field": "comparator", "quote": "It is a relatively simple and safe alternative to major plastic reconstruction which is often resorted to in such large-scale disease." }, { "field": "primaryOutcome", "quote": "Median drain-duration was 2 days (range 1-5 days) and postoperative stay was 2 days (range 0-5 days)." }, { "field": "result", "quote": "Median drain-duration was 2 days (range 1-5 days) and postoperative stay was 2 days (range 0-5 days). One complication arose: a wound infection with partial dehiscence which healed with conservative treatment. No recurrence or further complication arose in a 33-month follow-up (range 8-41 months)." } ] }, { "id": "pmid:18462233", "pmid": "18462233", "doi": "10.1111/j.1463-1318.2008.01563.x", "nctId": null, "pmcid": null, "title": "Rhomboid excision and Limberg flap for managing pilonidal sinus: long-term results in 411 patients", "firstAuthor": "Akin", "multipleAuthors": true, "journal": "Colorectal Dis", "year": 2008, "design": "case-series", "n": 411, "nField": "reported", "population": "people with pilonidal sinus disease", "intervention": "surgical removal of the sinus with a rhomboid excision and Limberg skin flap repair", "comparator": "none - single group of patients, no comparison treatment", "primaryOutcome": "time to return to normal activities after surgery (work, walking, sitting) and complication rates", "result": "average return to work was 12.4 days, pain-free walking took 13.4 days, pain-free sitting took 16.1 days, with a 2.91% recurrence rate", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a single-group case series without a comparison group, so it can only describe outcomes of this specific surgery, not prove it is better or faster than other treatments.", "directness": "indirect", "limitations": "No control or comparison group, retrospective record review, and the procedure (full excision with flap reconstruction) is different from simple incision and drainage of a pilonidal cyst.", "followUp": "109.2 +/- 4.5 months", "plainFinding": "Back to work in about 12 days.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/18462233/", "sourceText": "OBJECTIVE: To investigate the results of rhomboid excision and the Limberg flap procedure to treat pilonidal sinus disease. METHOD: The records of 411 patients with pilonidal sinus disease, who underwent rhomboid excision and Limberg flap procedure, were analysed. All sinus tracks were resected en bloc, and a Limberg flap was prepared from left or right gluteal region. A suction drain was routinely used. RESULTS: The mean follow-up period was 109.2 +/- 4.5 months (range: 12-183 months). Recurrence occurred in 12 (2.91%) patients who were all male. In 42 (10.21%) patients, anaesthesia or hypoaesthesia of the upper portion of the flap occurred; this was temporary in 25 patients. Twelve (2.91%) patients developed a seroma and 15 (3.64%) a wound infection. The average hospital stay was 3.2 days (range: 1-10 days), and the average time of return to work was 12.4 days (range: 7-18 days). The average time to walk without pain was 13.4 days (range: 10-28 days) and the average time to sitting on the toilet without pain was 16.1 days (range: 12-28 days). CONCLUSION: The Limberg flap procedure is effective and has a low complication rate, short time for returning to normal activity and short hospitalization.", "provenance": [ { "field": "n", "quote": "The records of 411 patients with pilonidal sinus disease" }, { "field": "population", "quote": "patients with pilonidal sinus disease" }, { "field": "intervention", "quote": "rhomboid excision and Limberg flap procedure" }, { "field": "comparator", "quote": "The records of 411 patients with pilonidal sinus disease, who underwent rhomboid excision and Limberg flap procedure, were analysed." }, { "field": "primaryOutcome", "quote": "the average time of return to work was 12.4 days" }, { "field": "result", "quote": "The average hospital stay was 3.2 days (range: 1-10 days), and the average time of return to work was 12.4 days (range: 7-18 days). The average time to walk without pain was 13.4 days (range: 10-28 days) and the average time to sitting on the toilet without pain was 16.1 days (range: 12-28 days)." }, { "field": "followUp", "quote": "The mean follow-up period was 109.2 +/- 4.5 months (range: 12-183 months)." } ] }, { "id": "pmid:17943897", "pmid": "17943897", "doi": "10.1002/14651858.CD006213.pub2", "nctId": null, "pmcid": null, "title": "Healing by primary versus secondary intention after surgical treatment for pilonidal sinus", "firstAuthor": "McCallum", "multipleAuthors": true, "journal": "Cochrane Database Syst Rev", "year": 2007, "design": "meta-analysis", "n": 1573, "nField": "reported", "population": "people with chronic pilonidal sinus needing surgery (not abscesses)", "intervention": "surgical excision of the sinus closed up (primary closure)", "comparator": "surgical excision left open to heal on its own (secondary intention)", "primaryOutcome": "time to healing, infection and recurrence after surgery", "result": "Closing the wound healed faster and let people return to work sooner, but left-open wounds were less likely to come back", "resultDirection": "mixed", "quality": "moderate", "qualityWhy": "It pools many randomized trials, but the included studies vary in technique and size, and some outcomes like pain and satisfaction had little usable data.", "directness": "indirect", "limitations": "Studies specifically on pilonidal abscess were excluded, and there was little data on pain, cost, or patient satisfaction.", "followUp": "", "plainFinding": "Faster healing but more recurrence after closure", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17943897/", "sourceText": "BACKGROUND: Pilonidal sinus arises in the hair follicles in the buttock cleft at the bottom of the backbone. The estimated incidence is 26 per 100,000, people, affecting men twice as often as women. The mean age of presentation is 21 years (men) and 19 years (women) respectively.Pilonidal sinus results in chronic discharging wounds that cause pain and impact upon quality of life and social function. These sinuses may become infected and present as acute abscesses. Management of these abscesses is uncontroversial and revolves around incision and drainage, however, the mode of surgical management of the chronic discharging sinus is debatable. Surgical strategies traditionally centre on excision of the sinus tracts followed by primary closure and healing by primary intention or leaving the wound open to heal by secondary intention. There is uncertainty as to whether open or closed surgical management is more effective. OBJECTIVES: To determine the relative effects of open compared with closed surgical treatment for pilonidal sinus on the outcomes of time to healing, infection and recurrence rate. SEARCH STRATEGY: We sought relevant trials from the Wounds Group Specialised Register (Searched 13/6/07); The Cochrane Central Register of Controlled Trials (CENTRAL) (2007, Issue 2); Ovid MEDLINE (1950 - May Week 5 200& ); Ovid EMBASE (1980 - 2007 Week 23); Ovid CINAHL (1982 - June Week 2 2007). We checked the bibliographies of review and primary articles for relevant studies and contacted authors of all included studies. SELECTION CRITERIA: All randomised controlled trials (RCTs) evaluating open with closed surgical treatment for pilonidal sinus. Exclusion criteria were: non-RCTs; children aged younger than 14 years and studies of pilonidal abscess. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, data extraction and methodological quality assessment of trials were conducted independently by two review authors. Data from eligible studies were recorded using data extraction forms and any disagreements were referred to a third review author. Results were presented using mean differences for continuous outcomes and relative risk with 95% confidence intervals for dichotomous outcomes. MAIN RESULTS: Eighteen studies were included (1573 patients). Twelve RCTs compared open healing with primary closure, 10 of which used midline closure and 2 trials used off-midline closure. Six studies compared midline and off-midline closure. Open compared with closed techniques: Evidence suggested more rapid healing after primary closure although there was no difference in the infection rate after wound closure. Recurrence was less likely to occur after open healing (RR 0.42; 95% CI 0.26 to 0.66) suggesting a 58% lower risk of recurrence after open wound healing compared with primary closure. Patients returned to work earlier after primary closure (WMD 10.48 days 95% CI 5.75 to 15.21 days). There was no difference between the two groups for other complications and length of stay. There were few useable data on cost, patient satisfaction and pain. Closed midline compared with closed off-midline: there was good evidence of slower healing, higher rates of infection (RR 4.70; 95% CI 1.93 to 11.45), higher rates of recurrence (Peto OR 4.95; 95% CI 2.18 to 11.24) and other complications (RR 8.94; 95% CI 2.10 to 38.02) after midline primary closure compared with off-midline closure techniques. AUTHORS' CONCLUSIONS: No clear benefit was shown for surgical management by primary closure or open healing by secondary intention. A clear benefit was shown for off-midline closure rather than midline closure after pilonidal sinus surgery. Off-midline closure should be the standard management when primary closure is the desired surgical option.", "provenance": [ { "field": "population", "quote": "Exclusion criteria were: non-RCTs; children aged younger than 14 years and studies of pilonidal abscess." }, { "field": "intervention", "quote": "excision of the sinus tracts followed by primary closure and healing by primary intention" }, { "field": "comparator", "quote": "leaving the wound open to heal by secondary intention" }, { "field": "primaryOutcome", "quote": "the outcomes of time to healing, infection and recurrence rate" }, { "field": "n", "quote": "Eighteen studies were included (1573 patients)." }, { "field": "result", "quote": "Evidence suggested more rapid healing after primary closure although there was no difference in the infection rate after wound closure. Recurrence was less likely to occur after open healing (RR 0.42; 95% CI 0.26 to 0.66)" }, { "field": "result", "quote": "Patients returned to work earlier after primary closure (WMD 10.48 days 95% CI 5.75 to 15.21 days)." } ] }, { "id": "pmid:17899165", "pmid": "17899165", "doi": "10.1007/s00423-007-0227-9", "nctId": null, "pmcid": null, "title": "Limberg flap procedure for pilonidal sinus disease: results of 353 patients", "firstAuthor": "Mentes", "multipleAuthors": true, "journal": "Langenbecks Arch Surg", "year": 2008, "design": "case-series", "n": 353, "nField": "reported", "population": "patients with pilonidal sinus disease (mostly young men)", "intervention": "Limberg flap surgery (rhomboid excision with skin flap reconstruction)", "comparator": "none - single group followed over time", "primaryOutcome": "recurrence rate and healing after surgery", "result": "average hospital stay was about 4.5 days and 3.1% had recurrence at end of follow-up", "resultDirection": "unclear", "quality": "low", "qualityWhy": "This is a case series without a comparison group, so it only describes outcomes after one type of surgery rather than proving an advantage.", "directness": "indirect", "limitations": "No control group for comparison; this describes a more extensive flap surgery, not simple drainage of a cyst.", "followUp": "4 weeks and 3, 6, 12, 18, and 24 months", "plainFinding": "Average hospital stay about 4.5 days", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17899165/", "sourceText": "PURPOSE: Pilonidal sinus disease is common especially in young adult males. Many surgical and nonsurgical methods have been described. Some surgical techniques for the treatment still have high recurrence rate. The aim of this study was to evaluate advantages and long term results of Limberg flap surgical technique. METHODS: From November 2001 to December 2004, 353 patients [335 male, 18 female; average age = 24.65 +/- 4.2 (range, 15-53) years] with primary or recurrent pilonidal sinus disease were operated on under spinal anesthesia by rhomboid excision and Limberg flap. Follow-up examinations were made at the end of the 4 weeks and 3, 6, 12, 18, and 24 months after surgery. RESULTS: The mean duration of symptoms was 23.28 +/- 16.09 (range, 2-140) months. The mean duration of hospital stay was 4.51 +/- 2.85 (range, 2-19) days. Thirty nine patients (11%) had recurrent disease. Total wound dehiscence and flap necrosis did not occur in any patient. Recurrences were observed in 11 patients (3.1%) at the end of the follow up period. CONCLUSION: Quick healing time, short hospital stay, early return to daily life, low complication and recurrence rate are the important advantages of the Limberg flap procedure. We think using closed suction drain in Limberg flap operation is not necessary. In the light of this study results, Limberg flap surgical technique may be an ideal operation for pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "353 patients" }, { "field": "population", "quote": "353 patients [335 male, 18 female; average age = 24.65 +/- 4.2 (range, 15-53) years] with primary or recurrent pilonidal sinus disease" }, { "field": "intervention", "quote": "operated on under spinal anesthesia by rhomboid excision and Limberg flap" }, { "field": "comparator", "quote": "We think using closed suction drain in Limberg flap operation is not necessary." }, { "field": "primaryOutcome", "quote": "evaluate advantages and long term results of Limberg flap surgical technique" }, { "field": "result", "quote": "The mean duration of hospital stay was 4.51 +/- 2.85 (range, 2-19) days." }, { "field": "result", "quote": "Recurrences were observed in 11 patients (3.1%) at the end of the follow up period." } ] }, { "id": "pmid:17828399", "pmid": "17828399", "doi": "10.1007/s10350-007-9049-7", "nctId": null, "pmcid": null, "title": "Results of the lateral advancing flap operation (modified Karydakis procedure) for the management of pilonidal sinus disease", "firstAuthor": "Bessa", "multipleAuthors": false, "journal": "Dis Colon Rectum", "year": 2007, "design": "case-series", "n": 82, "nField": "reported", "population": "patients with pilonidal sinus disease over the tailbone", "intervention": "modified Karydakis flap surgery to remove the pilonidal sinus", "comparator": "none - all patients received the same surgery", "primaryOutcome": "hospital stay length, complications, and recurrence after surgery", "result": "average 2-day hospital stay, 7.3% complication rate, no recurrences over follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small single-group study with no comparison group, so it can't show whether this technique is better than other options.", "directness": "indirect", "limitations": "No control group, single-center series, outcome measured was recurrence/complications rather than detailed recovery timeline.", "followUp": "20 +/- 6.8 months", "plainFinding": "Short hospital stay, low complications, no recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17828399/", "sourceText": "PURPOSE: The Karydakis procedure is one of the asymmetric flap techniques used in the treatment of sacrococcygeal pilonidal sinus disease. The procedure consists of an asymmetrical elliptical excision, mobilization of the flap from the median side of the wound, fixation of the base of the flap to the sacrococcygeal fascia, and suturing of its edge to the lateral one. A modification of the original technique consisting of unfixing the base of the flap to the sacrococcygeal fascia with the purpose of flattening the natal cleft has been applied and its results evaluated. METHODS: The present study included 82 consecutive patients. Data concerning age, gender, body mass index, duration of complaint, findings at presentation, and previous surgical treatment were obtained. The modified technique was applied in all patients. The postoperative complications and hospital stay were recorded. Patients were followed up by physical examination to detect recurrence. RESULTS: The hospital stay was two days for all patients. Postoperative complications were encountered in six patients (7.3 percent). Wound infection was encountered in four patients (4.9 percent), and subcutaneous fluid collections were encountered in two patients (2.4 percent). No recurrences were encountered throughout the 20 +/- 6.8 months mean follow-up duration. CONCLUSIONS: The low complication rate, short hospital stay, short healing time, high degree of patient satisfaction, and absence of recurrence render the present modified technique a viable option in the management of sacrococcygeal pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "The present study included 82 consecutive patients." }, { "field": "population", "quote": "sacrococcygeal pilonidal sinus disease" }, { "field": "intervention", "quote": "The modified technique was applied in all patients." }, { "field": "comparator", "quote": "The present study included 82 consecutive patients." }, { "field": "primaryOutcome", "quote": "The postoperative complications and hospital stay were recorded." }, { "field": "result", "quote": "The hospital stay was two days for all patients. Postoperative complications were encountered in six patients (7.3 percent)." }, { "field": "result", "quote": "No recurrences were encountered throughout the 20 +/- 6.8 months mean follow-up duration." } ] }, { "id": "pmid:17726856", "pmid": "17726856", "doi": "10.1024/1661-8157.96.31.1171", "nctId": null, "pmcid": null, "title": "[New concept in the treatment of the pilonidal sinus]", "firstAuthor": "Kapp", "multipleAuthors": true, "journal": "Praxis (Bern 1994)", "year": 2007, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with an infected pilonidal sinus (cyst near the tailbone)", "intervention": "small drainage cut of the abscess followed later by removal of the fistula tract", "comparator": "radical excision with reconstructive flap surgery for severe or recurrent cases", "primaryOutcome": "healing and complication rates after surgery", "result": "the two-step approach gave low complication rates and a high healing rate; the flap approach gave good cosmetic results", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is a review of a treatment concept based on the authors' experience and published studies, without patient numbers or measured recovery times.", "directness": "indirect", "limitations": "no participant numbers, no follow-up duration, and no objective measure of recovery time are reported.", "followUp": "", "plainFinding": "Good healing, low complications reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17726856/", "sourceText": "Symptomatic pilonidal sinus is characterized by an acute or a chronic inflammation. The surgical management of symptomatic pilonidal sinus is still a matter of discussion and no clear recommendations exists. On the basis of results from published studies and our own experience we developed a new two step therapy concept: Infected pilonidal were first drained by a small excision of the abscess (if possible in local anesthesia) followed by a close fistula excision. With this approach we were able to achieve a low morbidity and a high healing rate. In the case of extensive fistulating pilonidal sinus or recurrent disease we recommend radical excision and primary reconstructive flap what showed good aesthetic results.", "provenance": [ { "field": "intervention", "quote": "Infected pilonidal were first drained by a small excision of the abscess (if possible in local anesthesia) followed by a close fistula excision." }, { "field": "comparator", "quote": "In the case of extensive fistulating pilonidal sinus or recurrent disease we recommend radical excision and primary reconstructive flap what showed good aesthetic results." }, { "field": "result", "quote": "With this approach we were able to achieve a low morbidity and a high healing rate." }, { "field": "population", "quote": "Symptomatic pilonidal sinus is characterized by an acute or a chronic inflammation." }, { "field": "primaryOutcome", "quote": "we were able to achieve a low morbidity and a high healing rate" } ] }, { "id": "pmid:17551174", "pmid": "17551174", "doi": null, "nctId": null, "pmcid": null, "title": "Using negative pressure wound therapy following surgery for complex pilonidal disease: a case series", "firstAuthor": "Bendewald", "multipleAuthors": true, "journal": "Ostomy Wound Manage", "year": 2007, "design": "case-series", "n": 5, "nField": "reported", "population": "patients with complex, recurrent pilonidal disease with branching sinus tracts", "intervention": "wide surgical excision followed by negative pressure wound therapy", "comparator": "none (case series, historical comparison to moist saline dressings mentioned)", "primaryOutcome": "time to complete wound healing", "result": "mean time to complete healing was 12 weeks", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a tiny case series of only five patients with no comparison group, so it cannot show whether this treatment is better than alternatives.", "directness": "indirect", "limitations": "Very small sample size, no control group, complex (not simple) pilonidal disease, one patient discontinued treatment due to skin irritation, and long-term follow-up for recurrence was not done.", "followUp": "", "plainFinding": "Healed in about 12 weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17551174/", "sourceText": "Complex pilonidal disease, an uncommon manifestation of an anorectal condition, is characterized by chronic or recurrent abscesses with extensive, branching sinus tracts. Definitive treatment requires wide excision of all involved tissue followed by secondary intention healing or reconstructive surgery. All treatment options have unique advantages and disadvantages. Following recent reports that negative pressure wound therapy after surgery for complex pilonidal disease may be a useful alternative to moist saline dressing treatments, five patients (three men and two women, median age 21 years [range: 16 to 63 years]) with complex pilonidal disease (symptom duration range 6 months to 30 years) were treated on an outpatient basis. Following wide excision under general anesthesia, a portable negative pressure wound therapy device was applied. Mean wound defect size after excision was 11 cm x 4 cm x 5 cm, or 205 cm(3) (range 90 cm(3) to 410 cm(3)). Negative pressure wound therapy was used for an average of 6 weeks (range 4 to 9 weeks) and mean time to complete epithelialization was 12 weeks (range 9 to 22 weeks), including use of moist saline dressings post negative pressure wound therapy. Treatment was discontinued in one patient due to skin irritation. No other complications were observed. Long-term follow-up is required to assess the risk of recurrent pilonidal disease or wound failure following negative pressure wound therapy. Additional studies of negative pressure wound therapy in the management of pilonidal disease are warranted.", "provenance": [ { "field": "n", "quote": "five patients (three men and two women, median age 21 years [range: 16 to 63 years]) with complex pilonidal disease" }, { "field": "population", "quote": "five patients (three men and two women, median age 21 years [range: 16 to 63 years]) with complex pilonidal disease (symptom duration range 6 months to 30 years)" }, { "field": "intervention", "quote": "Following wide excision under general anesthesia, a portable negative pressure wound therapy device was applied." }, { "field": "comparator", "quote": "negative pressure wound therapy after surgery for complex pilonidal disease may be a useful alternative to moist saline dressing treatments" }, { "field": "primaryOutcome", "quote": "mean time to complete epithelialization was 12 weeks" }, { "field": "result", "quote": "mean time to complete epithelialization was 12 weeks (range 9 to 22 weeks), including use of moist saline dressings post negative pressure wound therapy" } ] }, { "id": "pmid:17357862", "pmid": "17357862", "doi": "10.1007/s10151-007-0320-7", "nctId": null, "pmcid": null, "title": "Impact of fibrin sealant on Limberg flap technique: results of a randomized controlled trial", "firstAuthor": "Altinli", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2007, "design": "rct", "n": 32, "nField": "reported", "population": "male patients with pilonidal cyst disease having flap surgery", "intervention": "fibrin sealant added during Limberg flap surgery", "comparator": "standard Limberg flap surgery alone", "primaryOutcome": "amount of fluid drained and length of hospital stay", "result": "fibrin sealant group had less drainage fluid and shorter hospital stay than the standard surgery group", "resultDirection": "benefit", "quality": "low", "qualityWhy": "very small single-center trial with only 16 patients per group, so results may not generalize.", "directness": "indirect", "limitations": "small sample size, abstract does not mention blinding or long-term follow-up", "followUp": "", "plainFinding": "Shorter hospital stay with sealant.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17357862/", "sourceText": "BACKGROUND: Pilonidal disease is a common chronic disorder mainly seen in the sacrococcygeal region, especially in young males. Different surgical methods have been described for the treatment. Limberg flap has low morbidity and recurrence rates. Fibrin sealant, a two-component tissue adhesive composed of fibrinogen and thrombin, has been used in a number of surgical procedures to achieve hemostasis and to seal tissues. The purpose of this study was to investigate the impact of fibrin sealant on the Limberg flap procedure. METHODS: Between January 2003 and January 2004, 32 male patients with pilonidal disease were randomly assigned to receive the standard Limberg flap technique (n=16) alone or with fibrin sealant application (n=16) before drain insertion. RESULTS: The two groups were similar for age and body mass index. The total drainage volume was 64.4+/-28.0 ml in the control group and 16.2+/-13.6 ml in the fibrin sealant group (p<0.001). Moreover, hospitalization time was 3.9+/-0.6 days in the control group and 2.0+/-0 days in the fibrin sealant group (p<0.001). CONCLUSIONS: Use of fibrin sealant for Limberg flap technique shortens hospitalization time, reduces drainage volume and is therefore recommended.", "provenance": [ { "field": "population", "quote": "32 male patients with pilonidal disease" }, { "field": "intervention", "quote": "the standard Limberg flap technique (n=16) alone or with fibrin sealant application (n=16) before drain insertion" }, { "field": "comparator", "quote": "the standard Limberg flap technique (n=16) alone" }, { "field": "primaryOutcome", "quote": "The total drainage volume was 64.4+/-28.0 ml in the control group and 16.2+/-13.6 ml in the fibrin sealant group" }, { "field": "result", "quote": "hospitalization time was 3.9+/-0.6 days in the control group and 2.0+/-0 days in the fibrin sealant group (p<0.001)" }, { "field": "n", "quote": "32 male patients with pilonidal disease were randomly assigned" } ] }, { "id": "pmid:17305995", "pmid": "17305995", "doi": "10.1111/j.1445-2197.2006.04002.x", "nctId": null, "pmcid": null, "title": "Sacrococcygeal pilonidal disease: sinotomy versus excisional surgery, a retrospective study", "firstAuthor": "Rabie", "multipleAuthors": true, "journal": "ANZ J Surg", "year": 2007, "design": "retrospective", "n": 81, "nField": "reported", "population": "Adults with pilonidal sinus or abscess treated at a Saudi Arabian hospital", "intervention": "Sinotomy (simply opening the sinus)", "comparator": "Excisional surgery (several types, including incision and drainage of abscess)", "primaryOutcome": "Disease recurrence and length of hospital stay", "result": "Sinotomy had lower recurrence (12.5%) and shorter hospital stay (2.8 days) than the overall average (26.9% recurrence, 4.1 days stay)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small retrospective chart review mixing several different surgery types without statistical comparison, so it only weakly supports any one conclusion.", "directness": "indirect", "limitations": "Retrospective design, small subgroup sizes, phone-based follow-up for recurrence, no statistical analysis reported, and procedures mixed together including drainage, excision, and flap surgery rather than isolating drainage alone.", "followUp": "", "plainFinding": "Shorter hospital stay with simpler surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/17305995/", "sourceText": "Pilonidal disease is a disease of relatively young people, the exact aetiology of which is unknown. Treatment options vary from simple incision to complex flap procedures. Each method has its advocates and they all have a variable recurrence rate. The multiplicity of procedures testifies to the lack of an optimal treatment method. The objective of this study is to compare sinotomy, that is, simply laying the sinus open with the more popular radical surgery, where the sinus-bearing tissues are excised. Patients who were admitted to Aseer Central Hospital, Saudi Arabia with a pilonidal sinus or abscess, in the period from April 1999 to January 2005, were identified. The medical records were reviewed and data related to the patient characteristics, disease process and the procedures carried out were noted. Identified patients were contacted by phone to check recurrence of the disease and their abidance to instructions regarding regular hair removal from the area. Eighty-one patients were included in the study. The median age was 24.2 years (range 16-60 years). There were 9 women and 72 men. All procedures were carried out under general anaesthesia except sinotomy, which was carried out under general or local anaesthesia. The surgical procedure was incision and drainage of abscess in 16 cases (19.8%), excision with primary closure in 29 cases (35.8%), excision by the open method in 15 cases (18.5%), sinotomy in 14 cases (17.3%) and rhomboid flap construction in 8 cases (9.9%). The overall recurrence rate was 26.9%, and the mean hospital stay was 4.1 days. Sinotomy had a low recurrence rate (12.5%) and a short hospital stay (2.8 days). Sinotomy has the advantages of simplicity, the possibility of operating under local anaesthesia, with an acceptable recurrence rate. We recommend sinotomy for pilonidal sinus and abscess alike, both in primary and recurrent cases.", "provenance": [ { "field": "n", "quote": "Eighty-one patients were included in the study." }, { "field": "population", "quote": "Patients who were admitted to Aseer Central Hospital, Saudi Arabia with a pilonidal sinus or abscess" }, { "field": "intervention", "quote": "sinotomy, that is, simply laying the sinus open" }, { "field": "comparator", "quote": "the more popular radical surgery, where the sinus-bearing tissues are excised" }, { "field": "primaryOutcome", "quote": "data related to the patient characteristics, disease process and the procedures carried out were noted" }, { "field": "result", "quote": "Sinotomy had a low recurrence rate (12.5%) and a short hospital stay (2.8 days)." } ] }, { "id": "pmid:16969609", "pmid": "16969609", "doi": "10.1007/s10151-006-0287-9", "nctId": null, "pmcid": null, "title": "Cutting seton for pilonidal disease: a new approach", "firstAuthor": "Rao", "multipleAuthors": false, "journal": "Tech Coloproctol", "year": 2006, "design": "case-series", "n": 8, "nField": "reported", "population": "adults with long-standing chronic pilonidal disease who had already had unsuccessful incision and drainage", "intervention": "a cutting seton (garrotte) placed under local anesthesia and tightened over two weeks", "comparator": "no comparison group; compared informally with traditional surgical treatment", "primaryOutcome": "wound healing, recurrence and patient satisfaction after the procedure", "result": "all wounds healed by secondary intention with minimal wound care and no recurrences over an average of 22.5 months", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a very small study of only 8 patients with no comparison group, so it can't reliably show how this treatment compares to others.", "directness": "indirect", "limitations": "Very small sample size, no control group, and the abstract itself calls these 'preliminary results' needing evaluation in a larger series with longer follow-up.", "followUp": "22.5 months", "plainFinding": "Healed well, no recurrences, minimal care", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16969609/", "sourceText": "I present a technique for dealing with chronic pilonidal disease that avoids use of general anesthesia, long hospital stay, complex wound care and prolonged disability that has so often been associated with more traditional surgical treatment in the past. Satisfactory resection was achieved by means of a single cutting seton (garrotte) in 8 patients, 5 males and 3 females ranging in age from 18 years to 31 years, all of whom had had prior unsuccessful incision and drainage for long-standing disease with local abscesses and suppuration. The seton was applied in an ambulatory care setting under local anesthesia. It was tied and progressively tightened over a period of two weeks. Complete excision of the diseased area was achieved and revascularization of the wounds site occurred with optimum healing by secondary intention, leaving an acceptable scar. It required minimal wound care. There were no recurrences over an average follow-up period of 22.5 months. All patients were uniformly satisfied. The encouraging preliminary results for this novel technique suggest that it is simple, safe and effective. It requires evaluation in a larger series with longer follow-up.", "provenance": [ { "field": "n", "quote": "Satisfactory resection was achieved by means of a single cutting seton (garrotte) in 8 patients" }, { "field": "population", "quote": "all of whom had had prior unsuccessful incision and drainage for long-standing disease with local abscesses and suppuration" }, { "field": "intervention", "quote": "The seton was applied in an ambulatory care setting under local anesthesia. It was tied and progressively tightened over a period of two weeks." }, { "field": "comparator", "quote": "more traditional surgical treatment in the past" }, { "field": "primaryOutcome", "quote": "There were no recurrences over an average follow-up period of 22.5 months. All patients were uniformly satisfied." }, { "field": "result", "quote": "Complete excision of the diseased area was achieved and revascularization of the wounds site occurred with optimum healing by secondary intention, leaving an acceptable scar. It required minimal wound care. There were no recurrences over an average follow-up period of 22.5 months." } ] }, { "id": "pmid:16808209", "pmid": "16808209", "doi": null, "nctId": null, "pmcid": null, "title": "Treatment of pilonidal disease with laser epilation", "firstAuthor": "Schulze", "multipleAuthors": true, "journal": "Am Surg", "year": 2006, "design": "case-series", "n": 23, "nField": "reported", "population": "people with pilonidal disease who had recurrent folliculitis after prior drainage or excision", "intervention": "laser hair removal added after surgical excision of the pilonidal area", "comparator": "no comparison group; outcomes compared before and after laser treatment", "primaryOutcome": "recurrence of folliculitis or need for further surgery", "result": "all patients still being followed had no recurrence of folliculitis or need for more surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "small uncontrolled case series without a comparison group, so it can't reliably show cause and effect.", "directness": "indirect", "limitations": "no control group, small number of patients, and some lost to follow-up", "followUp": "", "plainFinding": "Laser hair removal cut recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/16808209/", "sourceText": "Pilonidal disease is a debilitating, chronic disease of the natal cleft. It mainly involves the sacrococcygeal region and the presentation varies from asymptomatic pits to painful draining abscesses. Treatment options vary from observation to wide excision. Unfortunately, surgical treatment often results in recurrence. The etiologic agent remains in question, as does the optimal treatment. Our objective was to assess the efficacy of laser epilation as an adjunctive therapy to surgical excision of the pilonidal sinus. Eighteen men and five women were treated with laser epilation in our office from 2001 to 2004. All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision. After surgical excision of the affected area, a Vasculite Plus laser was used for the epilation treatments. Each session involved 9 to 12 treatments and the patients underwent an average of two sessions. All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures. During treatment, six of the men and one of the women experienced a superficial wound dehiscence. All healed with local wound care and continued laser treatments. Laser epilation is an effective adjunctive therapy for the treatment of pilonidal disease. Although not curative in and of itself, the removal of hair allows better healing and decreases the chance of recurrence by removal of a significant etiology of pilonidal disease.", "provenance": [ { "field": "n", "quote": "Eighteen men and five women were treated with laser epilation" }, { "field": "population", "quote": "All patients had experienced recurrent folliculitis and had undergone some form of drainage procedure or prior excision." }, { "field": "intervention", "quote": "After surgical excision of the affected area, a Vasculite Plus laser was used for the epilation treatments." }, { "field": "comparator", "quote": "Each session involved 9 to 12 treatments and the patients underwent an average of two sessions." }, { "field": "primaryOutcome", "quote": "All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures." }, { "field": "result", "quote": "All 19 of the patients that remain in follow-up report no recurrence of their folliculitis or need for further surgical procedures." } ] }, { "id": "pmid:15981071", "pmid": "15981071", "doi": "10.1007/s10350-005-0108-7", "nctId": null, "pmcid": null, "title": "Is routine cavity drainage necessary in Karydakis flap operation? A prospective, randomized trial", "firstAuthor": "Gurer", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2005, "design": "rct", "n": 50, "nField": "reported", "population": "patients with pilonidal sinus undergoing surgery", "intervention": "Karydakis flap surgery with suction drainage of the cavity", "comparator": "Karydakis flap surgery without suction drainage", "primaryOutcome": "wound complications, hospital stay, and recurrence rate", "result": "no difference in hospital stay or recurrence, but fewer fluid collections with drain", "resultDirection": "benefit", "quality": "low", "qualityWhy": "Small trial of only 50 patients, and this addresses whether drains help after a specific flap surgery, not general recovery time after cyst drainage.", "directness": "indirect", "limitations": "Small sample size; studies drainage as an addition to flap surgery, not simple incision and drainage of a cyst.", "followUp": "", "plainFinding": "Drain reduces fluid buildup after flap surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/15981071/", "sourceText": "PURPOSE: Different surgical techniques for pilonidal disease have been described in the literature. In this study our aim was to evaluate the influence of routine cavity drainage in the Karydakis flap technique. METHODS: Fifty patients with pilonidal sinus who underwent the Karydakis flap operation were evaluated prospectively. The patients were assigned randomly into two groups-with and without suction drainage of the cavity-and the effects of drains were studied in terms of wound complications, hospital stay, and recurrence rate. RESULTS: There was no significant difference between groups in term of length of hospital stay. Complication rate was 20 percent and the complications were caused exclusively by fluid collections. Wound infection, dehiscence, or failure was not observed in any of the patients. There has been no recurrence in any of the patients during the follow-up period. There was a significant increase in the number of fluid collections in patents without a suction drain. CONCLUSION: The present study indicates that routine cavity drainage reduces the incidence of fluid collection after the Karydakis flap operation.", "provenance": [ { "field": "n", "quote": "Fifty patients with pilonidal sinus who underwent the Karydakis flap operation were evaluated prospectively." }, { "field": "population", "quote": "Fifty patients with pilonidal sinus who underwent the Karydakis flap operation" }, { "field": "intervention", "quote": "with and without suction drainage of the cavity" }, { "field": "comparator", "quote": "with and without suction drainage of the cavity" }, { "field": "primaryOutcome", "quote": "the effects of drains were studied in terms of wound complications, hospital stay, and recurrence rate" }, { "field": "result", "quote": "There was no significant difference between groups in term of length of hospital stay." }, { "field": "result", "quote": "There was a significant increase in the number of fluid collections in patents without a suction drain." } ] }, { "id": "pmid:15900358", "pmid": "15900358", "doi": null, "nctId": null, "pmcid": null, "title": "Comparison between drainage and curettage in the treatment of acute pilonidal abscess", "firstAuthor": "Vahedian", "multipleAuthors": true, "journal": "Saudi Med J", "year": 2005, "design": "rct", "n": 150, "nField": "reported", "population": "patients with acute pilonidal abscess near the tailbone", "intervention": "curettage (scraping out) and drainage of the abscess", "comparator": "simple drainage alone", "primaryOutcome": "time to wound healing and recurrence of the abscess", "result": "curettage healed faster (96% vs 78.7% within 10 weeks) and had less recurrence (11% vs 42%) than drainage alone", "resultDirection": "benefit", "quality": "moderate", "qualityWhy": "it was a randomized trial with a reasonable number of patients, but details on blinding and dropout handling are limited.", "directness": "direct", "limitations": "not stated in detail beyond comparison methods; no mention of blinding", "followUp": "65 months", "plainFinding": "Faster healing with curettage than drainage", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/15900358/", "sourceText": "OBJECTIVE: Simple incision and drainage of a sacrococcygeal pilonidal abscess is associated with more than 40% recurrence. Definitive treatment of the chronic pilonidal sinus is recommended 4-8 weeks after incision and drainage. The present prospective clinical trial study was designed to compare the curettage and drainage of the acute abscess of the pilonidal sinus. Hospital stay, wound healing, and recurrence were noted. METHODS: This study was performed in Kerman University of Medical Sciences and Health Services, Iran from March 1999 to May 2004. One hundred and fifty patients who had an acute sacrococcygeal pilonidal abscess were randomly assigned to receive one of 2 drainage or curettage surgical procedures. All the surgical wounds were laid open, and daily sitting in a warm tub together with douche was recommended postoperatively. The 2 treatment modalities were compared in terms of the wound healing period, hospital stay, and postoperative complications using Chi-square and Student-t test. Patients with completed wound repair, consisting of 72 subjects in the curettage and 59 subjects in the drainage groups, were followed up to 65 months for the detection of recurrence by means of life table and Gehan s generalized Wilcoxon test. RESULTS: Most patients spent only one day in the hospital, with initial healing occurring in <2 months. Healing process in the curettage cases occurred more quickly than the drainage patients (96% versus 78.7%, p<0.001). In all cases, the treatment relieved symptoms, and all the patients returned to work 7-10 days after the treatment. Three patients in the curettage group (4%) and 16 patients in the drainage group (21.3%) did not complete wound healing within 10 weeks (p<0.001). Recurrence of disease was encountered significantly less in the curettage subjects than the drainage ones (11% versus 42%) (p<0.001). CONCLUSION: Unroofing and curettage, which is associated with higher rates of healing and lower rates of recurrence, may be the treatment of choice in the acute pilonidal abscess.", "provenance": [ { "field": "n", "quote": "One hundred and fifty patients who had an acute sacrococcygeal pilonidal abscess were randomly assigned" }, { "field": "population", "quote": "patients who had an acute sacrococcygeal pilonidal abscess" }, { "field": "intervention", "quote": "curettage and drainage of the acute abscess of the pilonidal sinus" }, { "field": "comparator", "quote": "Simple incision and drainage of a sacrococcygeal pilonidal abscess" }, { "field": "primaryOutcome", "quote": "Hospital stay, wound healing, and recurrence were noted." }, { "field": "result", "quote": "Healing process in the curettage cases occurred more quickly than the drainage patients (96% versus 78.7%, p<0.001)." }, { "field": "result", "quote": "Recurrence of disease was encountered significantly less in the curettage subjects than the drainage ones (11% versus 42%) (p<0.001)." }, { "field": "followUp", "quote": "followed up to 65 months for the detection of recurrence" } ] }, { "id": "pmid:15803819", "pmid": "15803819", "doi": null, "nctId": null, "pmcid": null, "title": "Radical treatment of acute pilonidal abscess by marsupialization", "firstAuthor": "Licheri", "multipleAuthors": true, "journal": "G Chir", "year": 2004, "design": "retrospective", "n": 43, "nField": "reported", "population": "patients with acute pilonidal abscess", "intervention": "drainage, curettage and marsupialization in one procedure", "comparator": "no comparator (single group, historical reference to simple drainage then later surgery)", "primaryOutcome": "time to complete wound healing", "result": "complete healing took 4-10 weeks in 95.3% of patients, with recurrence in 14.6% of healed cases", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small retrospective study of one group without a comparison group, so it cannot prove marsupialization is better than other options.", "directness": "direct", "limitations": "retrospective design, no comparison group, single center experience", "followUp": "not specified beyond healing time of 4-10 weeks", "plainFinding": "Healed in 4 to 10 weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/15803819/", "sourceText": "Simple drainage is the most common treatment of pilonidal abscess, but later definitive surgery is often necessary. However, radical treatment can also be performed in a single step by several procedures and even better results. The Authors describe the technique of marsupialization and analyse its long-term outcomes in a retrospective study. Between 1992 and 2001, 43 consecutive patients underwent drainage, curettage and marsupialization for acute pilonidal abscess. The procedure was carried out in outpatient setting (day surgery) after local or spinal anaesthesia. Management of the wound was left to the patient and was periodically checked at our out service. The average operating time was 20 minutes. Complete healing required 4-10 weeks in 95.3% of the patients; a persistent chronic fistula was observed in 4.7%. During the follow-up, 6 recurrences (14.6%) were observed in the healed patients. The treatment was then successful in 81.3% of the cases. Our experience shows that it is possible to carry out a radical management of pilonidal abscess in a single step with a high complete healing rate. Marsupialization proved to be a fast procedure and mainly feasible in the outpatient setting.", "provenance": [ { "field": "n", "quote": "43 consecutive patients underwent drainage, curettage and marsupialization for acute pilonidal abscess" }, { "field": "population", "quote": "43 consecutive patients underwent drainage, curettage and marsupialization for acute pilonidal abscess" }, { "field": "intervention", "quote": "drainage, curettage and marsupialization for acute pilonidal abscess" }, { "field": "comparator", "quote": "Simple drainage is the most common treatment of pilonidal abscess, but later definitive surgery is often necessary." }, { "field": "primaryOutcome", "quote": "Complete healing required 4-10 weeks in 95.3% of the patients" }, { "field": "result", "quote": "Complete healing required 4-10 weeks in 95.3% of the patients; a persistent chronic fistula was observed in 4.7%. During the follow-up, 6 recurrences (14.6%) were observed in the healed patients." } ] }, { "id": "pmid:15129309", "pmid": "15129309", "doi": "10.1007/s10350-004-0522-2", "nctId": null, "pmcid": null, "title": "Vacuum-assisted closure therapy: a new treatment option for recurrent pilonidal sinus disease. Report of three cases", "firstAuthor": "Lynch", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2004, "design": "case-series", "n": 3, "nField": "reported", "population": "people with pilonidal disease", "intervention": "vacuum-assisted closure therapy (with or without skin graft after excision)", "comparator": "no comparison group", "primaryOutcome": "wound healing", "result": "two cases had excision plus skin graft with vacuum therapy applied for four days; the third case healed completely with vacuum-assisted closure therapy alone", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "Only three cases with no comparison group, so it cannot show how this treatment compares to others.", "directness": "direct", "limitations": "Very small case series of only three patients with no control group and no long-term follow-up data reported.", "followUp": "", "plainFinding": "Small case series, healing achieved.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/15129309/", "sourceText": "No single treatment option available for symptomatic pilonidal disease is entirely satisfactory. In our department, we have treated successfully three cases of pilonidal disease with vacuum-assisted closure therapy. We describe our initial experience with this technique. In two cases, the pilonidal sinus was primarily excised, a split skin graft applied to cover the defect, and the vacuum-assisted closure pump applied over the skin graft for a period of four days on a continuous negative pressure of 50 mmHg. The third case was treated and completely healed with vacuum-assisted closure therapy alone. To our knowledge, this is the first report in the literature describing the use of vacuum-assisted closure therapy for this condition. We propose this therapy as an alternative adjunctive treatment for pilonidal disease.", "provenance": [ { "field": "n", "quote": "we have treated successfully three cases of pilonidal disease with vacuum-assisted closure therapy" }, { "field": "population", "quote": "we have treated successfully three cases of pilonidal disease with vacuum-assisted closure therapy" }, { "field": "intervention", "quote": "the pilonidal sinus was primarily excised, a split skin graft applied to cover the defect, and the vacuum-assisted closure pump applied over the skin graft for a period of four days on a continuous negative pressure of 50 mmHg" }, { "field": "comparator", "quote": "No single treatment option available for symptomatic pilonidal disease is entirely satisfactory." }, { "field": "primaryOutcome", "quote": "The third case was treated and completely healed with vacuum-assisted closure therapy alone." }, { "field": "result", "quote": "The third case was treated and completely healed with vacuum-assisted closure therapy alone." } ] }, { "id": "pmid:12972977", "pmid": "12972977", "doi": "10.1007/s10350-004-6729-4", "nctId": null, "pmcid": null, "title": "Modified Bascom's asymmetric midgluteal cleft closure technique for recurrent pilonidal disease: early experience in a military hospital", "firstAuthor": "Theodoropoulos", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2003, "design": "case-series", "n": 24, "nField": "reported", "population": "young male military service members with recurrent pilonidal disease", "intervention": "modified Bascom asymmetric midgluteal cleft closure surgery", "comparator": "none (no comparison group)", "primaryOutcome": "time to return to military duty and recurrence after surgery", "result": "full return to military duty in three weeks after surgery, one case of limited healing failure, no recurrences at a median follow-up of ten months", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small, uncontrolled case series with short follow-up, so it can't reliably show how well the technique works compared to other options.", "directness": "indirect", "limitations": "No control group, small number of patients with recurrent disease, short median follow-up of only ten months, and it studies a specific flap surgery rather than simple drainage.", "followUp": "ten months", "plainFinding": "Back to duty in three weeks", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12972977/", "sourceText": "PURPOSE: Despite the variety of surgical techniques proposed for the treatment of pilonidal disease, recurrence after its operative management remains a common occurrence. Relatively few data exist that focus on an optimal surgical approach that should be followed in cases of recurrent pilonidal disease. The aim of this study was to describe the technical details, analyze the advantages, and present the early results of a modified Bascom asymmetric midgluteal cleft closure technique applied in patients with recurrent pilonidal disease in a military hospital setting. METHODS: Among the 72 male military service patients (median age, 21; range, 18-26 years) who underwent surgery for pilonidal disease in the Military Hospital of Samos Island, Greece, there were 24 who presented with recurrent pilonidal disease eight months to four years after one to four operations each, which were performed before their enrollment in the Army (total of 43 operations). One or two midline pits were evident in 41.6 percent of the patients, whereas the rest had more complex disease. Three patients presented with acute purulent disease and required initial incision and drainage. The modified Bascom technique was applied, which involved an asymmetric ellipse-like, gluteal fat-preserving excision of the affected skin, the pilonidal sinus, and lateral tracts, a thick skin and fat tongue of tissue mobilization, and finally, complete lateralization of wound closure and flattening of midgluteal groove. RESULTS: All patients tolerated the procedure well, with minimal to moderate postoperative discomfort. Full return to military duty was possible in three weeks after surgery. There was one case of limited primary healing failure. No recurrences have developed in a short median follow-up period of ten months. CONCLUSION: The suggested modified Bascom technique is an attractive, safe, easily performed operation with minimal morbidity and can be reliably used as a second-line surgical option for recurrent pilonidal disease.", "provenance": [ { "field": "population", "quote": "24 who presented with recurrent pilonidal disease eight months to four years after one to four operations each" }, { "field": "intervention", "quote": "The modified Bascom technique was applied, which involved an asymmetric ellipse-like, gluteal fat-preserving excision of the affected skin, the pilonidal sinus, and lateral tracts, a thick skin and fat tongue of tissue mobilization, and finally, complete lateralization of wound closure and flattening of midgluteal groove." }, { "field": "comparator", "quote": "The suggested modified Bascom technique is an attractive, safe, easily performed operation with minimal morbidity and can be reliably used as a second-line surgical option for recurrent pilonidal disease." }, { "field": "primaryOutcome", "quote": "Full return to military duty was possible in three weeks after surgery." }, { "field": "result", "quote": "All patients tolerated the procedure well, with minimal to moderate postoperative discomfort. Full return to military duty was possible in three weeks after surgery. There was one case of limited primary healing failure. No recurrences have developed in a short median follow-up period of ten months." }, { "field": "n", "quote": "there were 24 who presented with recurrent pilonidal disease" } ] }, { "id": "pmid:12938615", "pmid": "12938615", "doi": null, "nctId": null, "pmcid": null, "title": "Drainage useful in the excision and closure \"per primam\" of pilonidal sinus: technical notes", "firstAuthor": "Benfatto", "multipleAuthors": true, "journal": "Chir Ital", "year": 2003, "design": "case-series", "n": 52, "nField": "reported", "population": "patients with pilonidal sinus", "intervention": "surgical removal of the sinus with wound closure and drainage tube", "comparator": "none", "primaryOutcome": "complications and recurrence after surgery", "result": "only minor complications in 3 cases and one recurrence", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small case series with no comparison group, so it can't reliably show how this method compares to others.", "directness": "indirect", "limitations": "No control group, small sample size, and the question asks about drainage of a cyst while this study describes surgical excision with drainage, not simple incision and drainage.", "followUp": "until removal of the suture", "plainFinding": "Few complications, low recurrence.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12938615/", "sourceText": "Pilonidal sinus treatment is still controversial, since all the most commonly used methods cause the patients considerable discomfort (\"open\" method) or increase the recurrence rate (\"closed\" method). In view of this, we reviewed our series of 52 patients treated by \"en bloc\" excision of all pathological tissue following closure \"per primam\" of the wound, after applying an aspirating drainage, which was then removed on day 2 or 3. Routine use of the drainage, antibiotic prophylaxis continued until postoperative day 6 or 7 and thorough daily disinfection of the wound and its neighbouring skin until removal of the suture, enabled us to achieve encouraging results (slight complications in 3 cases and only one recurrence).", "provenance": [ { "field": "n", "quote": "series of 52 patients" }, { "field": "population", "quote": "Pilonidal sinus treatment" }, { "field": "intervention", "quote": "\"en bloc\" excision of all pathological tissue following closure \"per primam\" of the wound, after applying an aspirating drainage, which was then removed on day 2 or 3" }, { "field": "comparator", "quote": "all the most commonly used methods cause the patients considerable discomfort (\"open\" method) or increase the recurrence rate (\"closed\" method)" }, { "field": "primaryOutcome", "quote": "encouraging results (slight complications in 3 cases and only one recurrence)" }, { "field": "result", "quote": "slight complications in 3 cases and only one recurrence" } ] }, { "id": "pmid:12928797", "pmid": "12928797", "doi": "10.1007/s00104-003-0657-z", "nctId": null, "pmcid": null, "title": "[Reconstructive surgical therapy of infected pilonidal sinus]", "firstAuthor": "Hegele", "multipleAuthors": true, "journal": "Chirurg", "year": 2003, "design": "case-series", "n": 38, "nField": "reported", "population": "young adults with infected pilonidal sinus (abscess)", "intervention": "incision and drainage of the abscess followed by radical excision and Limberg flap reconstruction", "comparator": "none (single treatment pathway, no comparison group)", "primaryOutcome": "long-term complications, recurrence, and hospital stay after treatment", "result": "87% had an uneventful postoperative course, 2.6% had recurrence, and average hospital stay was 3.2 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small, uncontrolled case series without a comparison group, so it can't reliably show how this approach compares to other treatments.", "directness": "direct", "limitations": "No control group; small sample size; single-center retrospective-style review of one treatment protocol", "followUp": "mean 23 months, range 1-36", "plainFinding": "Good healing, low complication rate.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12928797/", "sourceText": "INTRODUCTION: Infected sinus pilonidalis is common in young patients, causing much discomfort. Up to now, many different therapy options have been described. The aim of this study was to evaluate the longterm results for infected pilonidal sinus disease after primary drainage of the abscess, secondary rhomboid excision, and Limberg flap procedure. METHODS: 38 patients (5 female, 33 male, mean age 27,mean BMI 26.7 kg/m(2)) suffering from infected pilonidal sinus were first treated by incision of the abscess. After control of the inflammation (8-14 days), radical excision of the pilonidal sinus and defect closure by the Limberg flap procedure were performed. RESULTS: Two patients (5.2%) developed seroma and two (5.2%) developed infected hematoma. During follow-up, one patient (2.6%) showed recurrence. In 33 (87%), postoperative course and follow-up were uneventful (mean 23 months, range 1-36). The mean length of hospital stay was 3.2 days (range 1-4). CONCLUSIONS: In infected sinus pilonidalis disease, primary drainage of the abscess by incision, secondary radical rhomboid excision, and the Limberg flap procedure to close the defect can be recommended as a good therapeutic option due to its low complication rate, acceptable long-term results, and simple operative technique.", "provenance": [ { "field": "n", "quote": "38 patients (5 female, 33 male, mean age 27,mean BMI 26.7 kg/m(2)) suffering from infected pilonidal sinus" }, { "field": "population", "quote": "Infected sinus pilonidalis is common in young patients, causing much discomfort." }, { "field": "intervention", "quote": "38 patients (5 female, 33 male, mean age 27,mean BMI 26.7 kg/m(2)) suffering from infected pilonidal sinus were first treated by incision of the abscess." }, { "field": "comparator", "quote": "The aim of this study was to evaluate the longterm results for infected pilonidal sinus disease after primary drainage of the abscess, secondary rhomboid excision, and Limberg flap procedure." }, { "field": "primaryOutcome", "quote": "RESULTS: Two patients (5.2%) developed seroma and two (5.2%) developed infected hematoma. During follow-up, one patient (2.6%) showed recurrence." }, { "field": "result", "quote": "In 33 (87%), postoperative course and follow-up were uneventful (mean 23 months, range 1-36). The mean length of hospital stay was 3.2 days (range 1-4)." } ] }, { "id": "pmid:12836108", "pmid": "12836108", "doi": null, "nctId": null, "pmcid": null, "title": "[The comparison of incision and drainage with skin excision and curettage in the treatment of acute pilonidal abscess]", "firstAuthor": "Eryilmaz", "multipleAuthors": true, "journal": "Ulus Travma Acil Cerrahi Derg", "year": 2003, "design": "rct", "n": null, "nField": "not-reported", "population": "patients with acute pilonidal abscess", "intervention": "skin excision and curettage", "comparator": "incision and drainage", "primaryOutcome": "healing time, time returning to active work, and chronic pilonidal sinus development", "result": "skin excision and curettage took longer to heal (27 vs 19 days) and return to work (35 vs 26 days), but had lower chronic sinus rate (24% vs 76%)", "resultDirection": "mixed", "quality": "low", "qualityWhy": "small prospective comparative study with no reported patient numbers, randomization method, or blinding details.", "directness": "direct", "limitations": "Abstract does not report sample size, randomization method, or blinding.", "followUp": "", "plainFinding": "Excision heals slower but recurs less.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12836108/", "sourceText": "BACKGROUND: To compare therapeutic values of incision and drainage, with skin excision and curettage in surgical treatment of the patients with acute pilonidal abscess. METHODS: In this prospective study, patients with acute pilonidal abscess were divided into two groups. The first group of patients were treated with incision and drainage and the second with skin excision and curettage. Two treatment modalities were compared in terms of healing time, time of returning to active work and development of chronic pilonidal sinus rates with chi-square and student-t test. RESULTS: Development of chronic pilonidal sinus rate was 76% in incision and drainage group and 24% in skin excision and curettage group (p<0.001). Healing time and time of returning to active work were 27 and 35 days in skin excision and curettage group, 19 and 26 days in incision and drainage group, respectively (p<0.001). CONCLUSION: Skin excision and curettage, which is associated with lower rates of development of chronic pilonidal sinus, may be the treatment of choice in acute pilonidal abscess.", "provenance": [ { "field": "population", "quote": "patients with acute pilonidal abscess" }, { "field": "intervention", "quote": "skin excision and curettage" }, { "field": "comparator", "quote": "incision and drainage" }, { "field": "primaryOutcome", "quote": "healing time, time of returning to active work and development of chronic pilonidal sinus rates" }, { "field": "result", "quote": "Healing time and time of returning to active work were 27 and 35 days in skin excision and curettage group, 19 and 26 days in incision and drainage group, respectively (p<0.001)." }, { "field": "result", "quote": "Development of chronic pilonidal sinus rate was 76% in incision and drainage group and 24% in skin excision and curettage group (p<0.001)." } ] }, { "id": "pmid:12750948", "pmid": "12750948", "doi": "10.1007/s101510300001", "nctId": null, "pmcid": null, "title": "Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options", "firstAuthor": "Chintapatla", "multipleAuthors": true, "journal": "Tech Coloproctol", "year": 2003, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease, from asymptomatic pits to painful draining lesions near the tailbone", "intervention": "drainage of an abscess (with or without curettage) as one treatment option", "comparator": "other surgical approaches such as wide excision, primary closure, and limited excision", "primaryOutcome": "how quickly the wound heals and whether the sinus recurs", "result": "the review states that primary closure with a lateral approach appears to give the best results, but gives no specific time frame for recovery after drainage alone", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a general narrative review summarizing many past studies without new data, numbers of patients, or a systematic method for comparing outcomes.", "directness": "indirect", "limitations": "no original patient data, no stated follow-up duration, and no direct comparison of recovery time specifically after drainage versus other treatments.", "followUp": "", "plainFinding": "No specific recovery time reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12750948/", "sourceText": "Sacrococcygeal pilonidal disease is a common and well recognized entity. For many years the cause of sacrococcygeal pilonidal sinus has been matter of debate. When the treatment is considered, there was a frequent lack of success of the surgical methods of excision regarding morbidity, healing, recurrence and cure. All these factors rendered the acquired thesis of pilonidal sinus disease to be more accepted. In dealing with the pathogenesis of pilonidal sinus disease, Karydakis attributed the hair insertion process to three main factors: the invader, i.e. the loose hair; the force, which causes the insertion; and the vulnerability of the skin to the insertion of hair at the depth of the natal cleft. The sinus is initiated from a small midline opening lined by stratified squamous epithelium. Additional sinuses are frequent and have lateral openings. Malignant transformation is rare but cases of squamous cell carcinoma and verrucous carcinoma have been reported. Pilonidal sinus disease consists in a symptoms complex with presentations ranging from asymptomatic pits to painful draining lesions that are predominantly located in the sacrococcygeal region. Asymptomatic pits do not require treatment. Options for treatment of acute abscess include aspiration, drainage without curettage, and drainage with curettage. The choice of a particular surgical approach depends on the surgeon's familiarity with the procedure and perceived result in terms of low recurrence of sinus and a quick healing of resulting cavity or surgical wound. Conservative nonoperative management, closed methods, laying of track, wide excision and open drainage, wide excision and primary closure, and limited excision are the methods currently used. From the profusion of studies, it is apparent that various methods are being tried and no one method is universally acceptable. Recurrence rates vary with the technique, operator and length of follow-up. Primary closure with a lateral approach appears to give the best results.", "provenance": [ { "field": "population", "quote": "Pilonidal sinus disease consists in a symptoms complex with presentations ranging from asymptomatic pits to painful draining lesions that are predominantly located in the sacrococcygeal region." }, { "field": "intervention", "quote": "Options for treatment of acute abscess include aspiration, drainage without curettage, and drainage with curettage." }, { "field": "comparator", "quote": "Conservative nonoperative management, closed methods, laying of track, wide excision and open drainage, wide excision and primary closure, and limited excision are the methods currently used." }, { "field": "primaryOutcome", "quote": "recurrence of sinus and a quick healing of resulting cavity or surgical wound" }, { "field": "result", "quote": "Primary closure with a lateral approach appears to give the best results." } ] }, { "id": "pmid:12520844", "pmid": "12520844", "doi": "10.1024/1023-9332.8.6.255", "nctId": null, "pmcid": null, "title": "Pilonidal sinus: how to choose between excision and open granulation versus excision and primary closure? Study of a series of 141 patients operated on from 1991 to 1995", "firstAuthor": "Perruchoud", "multipleAuthors": true, "journal": "Swiss Surg", "year": 2002, "design": "retrospective", "n": 17, "nField": "reported", "population": "patients with an infected pilonidal sinus treated by incision and drainage alone", "intervention": "incision and drainage as sole treatment of an infected pilonidal sinus", "comparator": "excision and open granulation versus excision and primary closure", "primaryOutcome": "recurrence rate and length of follow-up after treatment", "result": "Five recurrences (29%) were noticed, requiring a new operation in all the cases.", "resultDirection": "harm", "quality": "low", "qualityWhy": "This is a small, non-randomized subgroup of only 17 patients within a larger retrospective series, and the authors themselves say the series is too limited to draw firm conclusions.", "directness": "indirect", "limitations": "Retrospective, non-randomized design; small subgroup size for the drainage-only arm; no healing time reported for this group, only recurrence data; authors state series too limited for firm conclusions.", "followUp": "37 months", "plainFinding": "High recurrence after simple drainage.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12520844/", "sourceText": "AIMS: The purpose of this study was to evaluate excision and open granulation versus excision and primary closure as treatments for pilonidal sinus. SUBJECTS AND METHODS: We evaluated a group of 141 patients operated on for a pilonidal sinus between 1991 and 1995. Ninety patients were treated by excision and open granulation, 34 patients by excision and primary closure and 17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus. RESULTS: The first group, receiving treatment of excision and open granulation, experienced the following outcomes: average length of hospital stay, four days; average healing time; 72 days; average number of post-operative ambulatory visits, 40; average off-work delay, 38 days; and average follow-up time, 43 months. There were five recurrences (6%) in this group during the follow-up period. For the second group treated by excision and primary closure, the corresponding outcome measurements were as follows: average length of hospital stay, four days; average healing time, 23 days; primary healing failure rate, 9%; average number of post-operative ambulatory visits, 6; average off-work delay, 21 days. The average follow-up time was 34 months, and two recurrences (6%) were observed during the follow-up period. In the third group, seventeen patients benefited from an incision and drainage as unique treatment. The mean follow-up was 37 months. Five recurrences (29%) were noticed, requiring a new operation in all the cases. DISCUSSION AND CONCLUSION: This series of 141 patients is too limited to permit final conclusions to be drawn concerning significant advantages of one form of treatment compared to the other. Nevertheless, primary closure offers the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for socioeconomical and comfort reasons.", "provenance": [ { "field": "n", "quote": "17 patients by incision and drainage, as a unique treatment of an infected pilonidal sinus" }, { "field": "population", "quote": "seventeen patients benefited from an incision and drainage as unique treatment" }, { "field": "intervention", "quote": "incision and drainage, as a unique treatment of an infected pilonidal sinus" }, { "field": "comparator", "quote": "excision and open granulation versus excision and primary closure" }, { "field": "primaryOutcome", "quote": "The mean follow-up was 37 months." }, { "field": "result", "quote": "Five recurrences (29%) were noticed, requiring a new operation in all the cases." } ] }, { "id": "pmid:11956785", "pmid": "11956785", "doi": "10.1007/s003830100683", "nctId": null, "pmcid": null, "title": "Excision with primary closure and suction drainage for pilonidal sinus in adolescent patients", "firstAuthor": "Serour", "multipleAuthors": true, "journal": "Pediatr Surg Int", "year": 2002, "design": "case-series", "n": 34, "nField": "reported", "population": "Teenagers aged 13 to 18 with pilonidal sinus", "intervention": "Surgical excision of the sinus with the wound stitched closed and a suction drain placed", "comparator": "No comparison group", "primaryOutcome": "Wound healing, complications, and recurrence after surgery", "result": "88.2% healed normally with no complications; drains were removed after 2 to 6 days (average 2.2 days); hospital stay averaged 2.3 days; 9.1% developed infections needing the wound reopened; one recurrence occurred at 3 years", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a small single-group study of only 34 patients with no comparison treatment, so it cannot show how this approach compares to other options.", "directness": "indirect", "limitations": "No control group for comparison, single-institution retrospective-style case series, and anesthesia type differed by age in a way not adjusted for.", "followUp": "12-month follow-up", "plainFinding": "Quick healing, drain out within days.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11956785/", "sourceText": "Controversy persists regarding the treatment of pilonidal sinus (PS). To evaluate the efficacy of excision with primary closure and closed-suction drainage in adolescent patients, between 1990 and 1999, 34 consecutive patients aged 13-18 years (mean 16.4) underwent PS excision with primary closure and suction drainage. Anesthesia was general in 16 (47%) and spinal in 18 (53%) with a statistical age difference ( P< 0.001) (15.5 vs 17.2 years, respectively). No complications due to the anesthetic were observed. Twenty-one patients (61.8%) had day-case surgery while the others were hospitalized for 2 to 4 days (average 2.3 days). The drain was removed on postoperative day 2 to 6 (average 2.2). Primary healing with no postoperative complications occurred in 30 patients (88.2%); 1 underwent partial opening of the wound because of rupture of the drainage tube during its removal. Postoperative infections requiring incision, drainage, and lay-open occurred in 3 cases (9.1%). No recurrence was found at 12-month follow-up. One recurrence (2.9%) was noted 3 years after surgery. Excision with primary closure and closed-suction drainage as an ambulatory procedure is thus a simple and effective method of treatment of uncomplicated PS in adolescents.", "provenance": [ { "field": "n", "quote": "34 consecutive patients aged 13-18 years" }, { "field": "population", "quote": "34 consecutive patients aged 13-18 years (mean 16.4) underwent PS excision" }, { "field": "intervention", "quote": "excision with primary closure and suction drainage" }, { "field": "comparator", "quote": "between 1990 and 1999, 34 consecutive patients aged 13-18 years (mean 16.4) underwent PS excision with primary closure and suction drainage" }, { "field": "primaryOutcome", "quote": "Primary healing with no postoperative complications occurred in 30 patients (88.2%)" }, { "field": "result", "quote": "The drain was removed on postoperative day 2 to 6 (average 2.2). Primary healing with no postoperative complications occurred in 30 patients (88.2%); 1 underwent partial opening of the wound because of rupture of the drainage tube during its removal. Postoperative infections requiring incision, drainage, and lay-open occurred in 3 cases (9.1%)." }, { "field": "followUp", "quote": "No recurrence was found at 12-month follow-up." } ] }, { "id": "pmid:11918891", "pmid": "11918891", "doi": "10.1016/s0002-9610(01)00876-5", "nctId": null, "pmcid": null, "title": "Excision and primary closure of pilonidal sinus using a drain for antiseptic wound flushing", "firstAuthor": "Tritapepe", "multipleAuthors": true, "journal": "Am J Surg", "year": 2002, "design": "case-series", "n": 243, "nField": "reported", "population": "patients with pilonidal sinus", "intervention": "excision of pilonidal sinus with primary closure and drain flushing with antiseptic solution", "comparator": "none reported", "primaryOutcome": "wound healing, complications, and recurrence after surgery", "result": "all patients healed without complications and had no recurrences over long-term follow-up", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single group of patients with no comparison treatment, so we can't tell if another method would have done better or worse.", "directness": "direct", "limitations": "No control group; single surgical technique without comparison to other drainage/healing methods.", "followUp": "5 to 15 years", "plainFinding": "Full healing, no recurrences long-term.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/11918891/", "sourceText": "BACKGROUND: In the case of pilonidus sinus treated with primary intention surgery the uneventful healing is still difficult to obtain, as indirectly proven by the number of different procedures that have been suggested, such as cyst excision with or without primary closure, excision followed by marsupialisation, and excision followed by skin flap transposition. The procedure described here involves excision and primary closure, with a drain being used to flush the operative cavity with an antiseptic solution. METHODS: Two hundred and forty-three patients (173 men and 70 women) were treated by excising the pilonidal sinus and placing a 12F suction drain at the base of the wound, with its tip being brought out in the left gluteal region at least 5 cm laterally to the lower end of the suture. Suction was stopped on the first postoperative day and the drain was cut just above the skin. On day 2, a 5F catheter was inserted through the drain and the cavity was flushed with an antiseptic solution followed by sterile saline solution; the same treatment was repeated on days 4 and 6. The drain was removed on day 8 or 9, some of the stitches on day 8 or 9 and the rest on day 9 or 10. The surgery was performed on a day hospital basis in 207 cases; the remaining 36 were hospitalized overnight and discharged on the following day. RESULTS: Healing was always by first intention, with none of the 243 patients experiencing any complications. The postoperative follow-up now ranges from 5 to 15 years, and there have not been any recurrences. CONCLUSIONS: The drainage of blood from the bottom of the wound and the use of antiseptic/saline flushing are essential for primary intention healing and the avoidance of recurrences.", "provenance": [ { "field": "n", "quote": "Two hundred and forty-three patients (173 men and 70 women) were treated" }, { "field": "population", "quote": "Two hundred and forty-three patients (173 men and 70 women) were treated by excising the pilonidal sinus" }, { "field": "intervention", "quote": "excising the pilonidal sinus and placing a 12F suction drain at the base of the wound, with its tip being brought out in the left gluteal region" }, { "field": "comparator", "quote": "The procedure described here involves excision and primary closure, with a drain being used to flush the operative cavity with an antiseptic solution." }, { "field": "primaryOutcome", "quote": "Healing was always by first intention, with none of the 243 patients experiencing any complications." }, { "field": "result", "quote": "Healing was always by first intention, with none of the 243 patients experiencing any complications. The postoperative follow-up now ranges from 5 to 15 years, and there have not been any recurrences." } ] }, { "id": "pmid:10826434", "pmid": "10826434", "doi": "10.1007/BF02235591", "nctId": null, "pmcid": null, "title": "Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure", "firstAuthor": "Akinci", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 2000, "design": "case-series", "n": 112, "nField": "reported", "population": "patients with pilonidal sinus (excluding pilonidal abscess or extensive gluteal involvement)", "intervention": "asymmetric excision and primary closure using a suction drain and subcuticular skin closure", "comparator": "none (single-group study)", "primaryOutcome": "healing time, time off work, complications and recurrence after surgery", "result": "mean healing time was 13.2 days, mean time off work was 12.4 days, and complication rate was 7.14 percent", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This was a single-group case series without a comparison treatment, so it cannot show whether this method is better than other options.", "directness": "indirect", "limitations": "No control or comparator group; abstract notes exclusion of pilonidal abscess cases, so findings may not reflect drainage of an active abscess.", "followUp": "followed up for a mean of 2.4 years", "plainFinding": "Healed in about 13 days.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/10826434/", "sourceText": "PURPOSE: This study was planned to evaluate prospectively the results of 112 pilonidal sinus cases treated surgically by using asymmetric excision and primary closure with suction drain and subcuticular skin closure. It is aimed at elimination of the causative factors of pilonidal sinus. METHOD: The patient's age, profession, weight and height, symptoms and signs, duration of symptoms, previous treatments, operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted. All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically. The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Penrose drains were placed in the first eight (7.14 percent) cases, but suction drains were placed in others. The cases were followed up for a mean of 2.4 years. RESULTS: Twenty-eight (25 percent) cases had undergone previous operative procedures. Of 112 patients 106 (94.6 percent) were male. Mean age was 22.1 years. Mean history of disease was 4.2 years. The overall complication rate was 7.14 percent. Two (1.8 percent) wound infections, two wound breakdowns, three (2.7 percent) collections, and one (0.9 percent) recurrence were recorded. The collections were reduced to zero after first eight cases by using a suction drain. Sixty-eight of the patients (60.7 percent) had body weight over 90 kg, and the mean body mass index was 24.8. The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days. There were no anesthetic or surgical deaths. CONCLUSION: The natal cleft is flattened and the incision scar and the incision line is transferred from the midline to the lateral side by performing the asymmetric excision and primary closure, and thus the essential cause of pilonidal sinus is eliminated. The procedure is simple, the complications and recurrences are very low, and it is seen to be an excellent procedure in the surgical treatment of uncomplicated pilonidal sinus disease.", "provenance": [ { "field": "n", "quote": "112 pilonidal sinus cases treated surgically" }, { "field": "population", "quote": "All pilonidal sinus cases except pilonidal abscess and extensive gluteal involvement were treated surgically." }, { "field": "intervention", "quote": "asymmetric excision and primary closure with suction drain and subcuticular skin closure" }, { "field": "comparator", "quote": "The procedure consists of an eccentric, elliptical excision of the affected tissue, mobilization of the flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one." }, { "field": "primaryOutcome", "quote": "operation time and cost, hospital stay, return to normal activity, complications, pathologic and microbiologic examinations, and recurrences were noted" }, { "field": "result", "quote": "The mean hospital stay was 2.6 days, and the mean time off work was 12.4 days. The average healing time was 13.2 days." } ] }, { "id": "pmid:10765903", "pmid": "10765903", "doi": "10.1046/j.1440-1622.2000.01785.x", "nctId": null, "pmcid": null, "title": "Pilonidal disease in Singapore: clinical features and management", "firstAuthor": "Lee", "multipleAuthors": true, "journal": "Aust N Z J Surg", "year": 2000, "design": "retrospective", "n": 61, "nField": "reported", "population": "patients with pilonidal disease treated at a colorectal surgery unit", "intervention": "surgical treatment of pilonidal disease (various techniques including incision and drainage, laying open, marsupialization, primary closure, flap procedure)", "comparator": "different surgical techniques compared with each other", "primaryOutcome": "time required for wound healing", "result": "no difference between techniques in healing time, averaging 48 days, with wound dehiscence after primary closure and flap procedures", "resultDirection": "no-benefit", "quality": "low", "qualityWhy": "this is a small retrospective database study comparing several techniques without randomization, so results are less reliable.", "directness": "indirect", "limitations": "retrospective design, small sample size, no randomization between treatment groups", "followUp": "", "plainFinding": "Healing took about 48 days.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/10765903/", "sourceText": "BACKGROUND: Pilonidal disease has not been well documented in Asian people. The aims of the present study were to investigate any variations in the clinical features and effectiveness of various surgical treatments in such a population. METHODS: A prospectively collected computerized database of 61 consecutive patients admitted to a specialist colorectal unit over a 9-year period was studied. The five methods of surgical treatment used during this period (incision and drainage; laying open; marsupialization; primary closure; and the flap procedure) were compared. RESULTS: There were 38 men and 23 women with a mean age of 27+/-1.02 years. Pilonidal disease was significantly more common among the Indian people (52.5% of patients) than the other ethnic races in the Singaporean community (P < 0.001). Chronic discharging sinuses were the most common presentation (93.4%). There were no differences between the various surgical techniques employed with regard to the time required for wound healing (mean: 48+/-21 days) and recurrence rates (4/61, 6.6%). Wound dehiscence after primary wound closure (10%) and flap procedures (42%) meant that the overall healing rate was not faster than when the wound was just laid open. Furthermore, flap procedures required a longer hospitalization than other procedures (P = 0.005). CONCLUSION: Pilonidal disease was more common among Indian people, the more hirsute among the Singaporean population. Primary closure and flap procedure did not improve overall wound healing because of dehiscence.", "provenance": [ { "field": "n", "quote": "A prospectively collected computerized database of 61 consecutive patients" }, { "field": "population", "quote": "61 consecutive patients admitted to a specialist colorectal unit" }, { "field": "intervention", "quote": "The five methods of surgical treatment used during this period (incision and drainage; laying open; marsupialization; primary closure; and the flap procedure) were compared." }, { "field": "comparator", "quote": "There were no differences between the various surgical techniques employed with regard to the time required for wound healing" }, { "field": "primaryOutcome", "quote": "the time required for wound healing (mean: 48+/-21 days)" }, { "field": "result", "quote": "There were no differences between the various surgical techniques employed with regard to the time required for wound healing (mean: 48+/-21 days) and recurrence rates (4/61, 6.6%)." } ] }, { "id": "pmid:9823811", "pmid": "9823811", "doi": "10.1007/BF02237061", "nctId": null, "pmcid": null, "title": "Are postoperative drains necessary with the Limberg flap for treatment of pilonidal sinus?", "firstAuthor": "Erdem", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 1998, "design": "rct", "n": 40, "nField": "reported", "population": "patients with pilonidal sinus having surgery to remove it", "intervention": "surgical removal with flap reconstruction and no wound drain", "comparator": "same surgery but with a wound drain left in place", "primaryOutcome": "wound complications, length of hospital stay, and return of the cyst", "result": "no difference in wound complications or recurrence, but hospital stay was significantly longer when a drain was used", "resultDirection": "mixed", "quality": "low", "qualityWhy": "this was a small trial of only 40 patients looking at a specific flap surgery technique, not at drainage of a cyst alone.", "directness": "indirect", "limitations": "small sample size; studies a specific flap reconstruction technique rather than simple incision and drainage of a pilonidal cyst", "followUp": "", "plainFinding": "No drain means shorter hospital stay.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/9823811/", "sourceText": "PURPOSE: Different methods for managing pilonidal sinus have been described in the literature. Our purpose was to evaluate the influence of postoperative drainage in Limberg flaps. METHODS: Forty patients with pilonidal sinus undergoing radical excision and reconstruction with Limberg flap between 1994 and 1996 were evaluated prospectively. After patients were assigned randomly to the two groups, the effects of drains were studied statistically in terms of wound complications, hospital stay, and recurrence rate. RESULTS: Except for two minor transient wound dehiscences, in all cases primary healing was achieved. Early wound complication rate was 7.5 percent and recurrence rate was 2.5 percent for both groups. There was no significant difference between the groups in early wound complications (P > 0.05). The length of hospital stay was significantly longer in the drainage group (P < 0.001). CONCLUSION: We conclude that Limberg flaps with no drains in place will result in shorter hospital stays without deleteriously affecting the surgical results of wide excision and primary closure with well-vascularized tissue.", "provenance": [ { "field": "n", "quote": "Forty patients with pilonidal sinus undergoing radical excision and reconstruction with Limberg flap between 1994 and 1996 were evaluated prospectively." }, { "field": "population", "quote": "Forty patients with pilonidal sinus undergoing radical excision and reconstruction with Limberg flap between 1994 and 1996 were evaluated prospectively." }, { "field": "intervention", "quote": "Limberg flaps with no drains in place" }, { "field": "comparator", "quote": "the effects of drains were studied statistically in terms of wound complications, hospital stay, and recurrence rate" }, { "field": "primaryOutcome", "quote": "the effects of drains were studied statistically in terms of wound complications, hospital stay, and recurrence rate" }, { "field": "result", "quote": "There was no significant difference between the groups in early wound complications (P > 0.05). The length of hospital stay was significantly longer in the drainage group (P < 0.001)." } ] }, { "id": "pmid:12743878", "pmid": "12743878", "doi": null, "nctId": null, "pmcid": null, "title": "[Day-surgery treatment of pilonidal sinus]", "firstAuthor": "Calbo", "multipleAuthors": true, "journal": "Chir Ital", "year": 1997, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus disease", "intervention": "open surgical treatment, closed surgical treatment, and carbon-dioxide laser", "comparator": "open method versus closed method", "primaryOutcome": "healing time and complications", "result": "carbon-dioxide laser was reported to prevent complications and shorten healing time in the open method, and the closed method was said to have economic advantages", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a discussion of historical background and author experience rather than a controlled study with measured outcomes.", "directness": "direct", "limitations": "no study design, patient numbers, or measured outcomes are reported; conclusions are based on authors' general experience.", "followUp": "", "plainFinding": "Laser said to speed healing.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/12743878/", "sourceText": "Authors discuss ethiopathogenus of pilonidal disease after a historical background and support acquired-congenital theory. Open and closed treatment are reported on the acute and chronic phases, highlighting economical advantages of closed method. Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method.", "provenance": [ { "field": "population", "quote": "pilonidal disease" }, { "field": "intervention", "quote": "Open and closed treatment are reported on the acute and chronic phases" }, { "field": "intervention", "quote": "Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method." }, { "field": "comparator", "quote": "highlighting economical advantages of closed method" }, { "field": "primaryOutcome", "quote": "to prevent complications and to shorten healing time in open method" }, { "field": "result", "quote": "Carbon-dioxide laser on Authors experience was very useful to prevent complications and to shorten healing time in open method." } ] }, { "id": "pmid:8787316", "pmid": "8787316", "doi": null, "nctId": null, "pmcid": null, "title": "[Pilonidal sinus]", "firstAuthor": "Berger", "multipleAuthors": true, "journal": "Ann Chir", "year": 1995, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal sinus/cyst disease", "intervention": "limited excision with immediate closure (non-infected cases) or exposure with immediate resection (abscess cases)", "comparator": "wide excision and secondary closure techniques", "primaryOutcome": "complications and recurrence after surgery", "result": "not clearly reported numerically; recurrence rate ranged from 5 to 40% regardless of technique, with high morbidity", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is a narrative review of the literature and the authors' own experience, without reported study numbers or recovery times, so it cannot reliably measure recovery.", "directness": "indirect", "limitations": "no patient numbers, no recovery time data, and treatment approach described as controversial with no statistical comparison", "followUp": "", "plainFinding": "Recovery time not reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8787316/", "sourceText": "Pilonidal sinus, acute or chronic suppuration of the sacrococcygeal region, is a common benign disease. Its treatment, usually surgical, remains controversial, between wide excision and limited excision and between primary closure and secondary closure. On the basis of our experience and a review of the literature, we propose limited excision with immediate closure for non-infected operations and exposure with immediate resection for pilonidal abscesses. Regardless of the technique used, the morbidity is high, associated with a recurrence rate of between 5 and 40%.", "provenance": [ { "field": "intervention", "quote": "we propose limited excision with immediate closure for non-infected operations and exposure with immediate resection for pilonidal abscesses" }, { "field": "comparator", "quote": "between wide excision and limited excision and between primary closure and secondary closure" }, { "field": "population", "quote": "Pilonidal sinus, acute or chronic suppuration of the sacrococcygeal region, is a common benign disease" }, { "field": "result", "quote": "the morbidity is high, associated with a recurrence rate of between 5 and 40%" }, { "field": "primaryOutcome", "quote": "the morbidity is high, associated with a recurrence rate of between 5 and 40%" } ] }, { "id": "pmid:7985066", "pmid": "7985066", "doi": "10.1016/s0039-6109(16)46482-0", "nctId": null, "pmcid": null, "title": "Pilonidal disease", "firstAuthor": "Surrell", "multipleAuthors": false, "journal": "Surg Clin North Am", "year": 1994, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal cysts, including acute abscesses and chronic disease", "intervention": "incision and drainage followed by excision with marsupialization or beveling of skin edges", "comparator": "", "primaryOutcome": "", "result": "The abstract gives treatment recommendations but does not report healing or recovery time data", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is an expert opinion/narrative review with no study data, patient numbers, or outcome measurements reported.", "directness": "indirect", "limitations": "No original data, no patient numbers, no measured outcomes or follow-up times are given; it is author preference and recommendation only.", "followUp": "", "plainFinding": "No recovery time data given.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7985066/", "sourceText": "It is the author's preference and recommendation that an acutely infected pilonidal abscess be urgently drained with a simple incision and drainage procedure that is not necessarily viewed as definitive treatment. The patient should be so instructed. The definitive treatment of chronic pilonidal disease can be accomplished in a variety of ways, but our recommendation is excision of all infected tissue and sinus tracts through an elliptical incision with either marsupialization of the wound or beveling of the skin edges. Both marsupialization and beveling serve to minimize the chance of premature skin closure and promote complete healing of the site from the inside out. Weekly postoperative follow-up is strongly encouraged to assess progress and promote proper wound healing.", "provenance": [ { "field": "intervention", "quote": "an acutely infected pilonidal abscess be urgently drained with a simple incision and drainage procedure that is not necessarily viewed as definitive treatment" }, { "field": "intervention", "quote": "excision of all infected tissue and sinus tracts through an elliptical incision with either marsupialization of the wound or beveling of the skin edges" }, { "field": "population", "quote": "Pilonidal disease" }, { "field": "result", "quote": "Weekly postoperative follow-up is strongly encouraged to assess progress and promote proper wound healing." } ] }, { "id": "pmid:7956585", "pmid": "7956585", "doi": "10.1007/BF02049819", "nctId": null, "pmcid": null, "title": "Which technique for treatment of pilonidal sinus--open or closed?", "firstAuthor": "Füzün", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 1994, "design": "rct", "n": 110, "nField": "reported", "population": "adults with chronic pilonidal sinus", "intervention": "surgical excision with primary wound closure (stitched shut)", "comparator": "surgical excision with wound left open (Obeid's open technique)", "primaryOutcome": "length of hospital stay, time to return to work, wound infection rate, and recurrence rate", "result": "Primary closure led to longer hospital stays but earlier return to work; infection rates (3.6% vs 1.8%) and recurrence rates (4.4% vs 0%) were not significantly different between groups", "resultDirection": "mixed", "quality": "low", "qualityWhy": "It was a randomized trial but only 91 of 110 patients were followed, follow-up time varied widely, and the sample was small.", "directness": "indirect", "limitations": "Only 91 of 110 randomized patients were followed up, follow-up duration ranged widely (4 months to 3 years), and this studies surgical excision technique rather than simple incision and drainage.", "followUp": "four months to three years", "plainFinding": "Faster return to work with stitched closure.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7956585/", "sourceText": "PURPOSE: After excision of the pilonidal sinus, some surgeons leave the wound open, and others close the wound primarily. The aim of this study is to compare length of hospital stay, length of time to return to work, wound infection rate, and recurrence rate in chronic pilonidal sinus patients, after modification of both closed and open techniques. METHODS: One hundred ten patients who had chronic-stage pilonidal sinus were randomly assigned to receive one of two excisional surgical procedures. One-half were treated by surgical excision and primary closure (closed technique, Group A). The other one-half were treated with Obeid's surgical excision (open technique, Group B). RESULTS: Ninety-one (46 in Group A and 45 in Group B) of 110 patients were followed for a period four months to three years. Although patients with primary closure had significantly longer hospital stays (P < 0.05) than patients in the open group, they returned to work significantly earlier (P < 0.05). In Group A and Group B, infection rates were 3.6 percent and 1.8 percent (P > 0.01), and recurrence rates were 4.4 percent and 0 percent (P > 0.01), respectively. CONCLUSION: Because both techniques have very low complication rates, treatment of chronic pilonidal sinus should be based on patient preference and characteristics, especially employment status.", "provenance": [ { "field": "n", "quote": "One hundred ten patients who had chronic-stage pilonidal sinus" }, { "field": "population", "quote": "patients who had chronic-stage pilonidal sinus" }, { "field": "intervention", "quote": "surgical excision and primary closure (closed technique, Group A)" }, { "field": "comparator", "quote": "Obeid's surgical excision (open technique, Group B)" }, { "field": "primaryOutcome", "quote": "compare length of hospital stay, length of time to return to work, wound infection rate, and recurrence rate" }, { "field": "result", "quote": "patients with primary closure had significantly longer hospital stays (P < 0.05) than patients in the open group, they returned to work significantly earlier (P < 0.05)" }, { "field": "result", "quote": "infection rates were 3.6 percent and 1.8 percent (P > 0.01), and recurrence rates were 4.4 percent and 0 percent (P > 0.01), respectively" }, { "field": "followUp", "quote": "followed for a period four months to three years" } ] }, { "id": "pmid:8080372", "pmid": "8080372", "doi": "10.1001/archsurg.1994.01420330028006", "nctId": null, "pmcid": null, "title": "Pilonidal sinus disease. The conservative approach", "firstAuthor": "Armstrong", "multipleAuthors": true, "journal": "Arch Surg", "year": 1994, "design": "retrospective", "n": 330, "nField": "reported", "population": "patients treated for pilonidal sinus disease at army hospitals", "intervention": "conservative, nonexcisional therapy (hair removal, hygiene, limited incision and drainage)", "comparator": "excisional surgery for pilonidal sinus disease", "primaryOutcome": "time to complete healing measured in occupied-bed days", "result": "conservative therapy led to much faster healing (83 bed-days in 101 patients) compared with excisional surgery (4760 bed-days in 229 patients)", "resultDirection": "benefit", "quality": "low", "qualityWhy": "The study was nonrandomized and combined a small pilot cohort with a retrospective review, so bias and confounding can't be ruled out.", "directness": "indirect", "limitations": "Nonrandomized, partly retrospective design comparing different time periods and institutions.", "followUp": "", "plainFinding": "Faster healing with conservative care.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/8080372/", "sourceText": "OBJECTIVE: To examine the role of conservative, nonexcisional methods in the treatment of pilonidal sinus disease. DESIGN: Pilot nonrandomized cohort study and follow-up retrospective study. SETTING AND PATIENTS: In the pilot study, all patients treated for pilonidal sinus disease consecutively over 3 years at an Army community hospital, and in the follow-up study within a closed federal population, all patients admitted with a diagnosis of pilonidal sinus disease over 17 years to an Army medical center. INTERVENTIONS: Conservative, nonexcisional therapy (meticulous hair control by natal cleft shaving, improved perineal hygiene, and limited lateral incision and drainage for abscess) with initial comparison to excisional procedures. MAIN OUTCOME MEASURES: Occupied-bed days for conservative vs excisional therapy during a 3-year pilot study and the number of admissions and procedures performed for pilonidal sinus disease at an institution dedicated to conservative treatment alone. RESULTS: Complete healing over 83 occupied-bed days was demonstrated in 101 consecutive cases managed during 1 year with the conservative method, whereas slower healing over 4760 occupied-bed days was observed in 229 patients undergoing 240 operative procedures during the preceding 2 years. With application of conservative treatment over 17 years, only 23 excisional operations were performed. CONCLUSIONS: Conservative therapy effectively controls pilonidal sinus disease in the nonoperative outpatient setting while promoting near-normal work status and is preferred over excisional operations.", "provenance": [ { "field": "n", "quote": "101 consecutive cases managed during 1 year with the conservative method, whereas slower healing over 4760 occupied-bed days was observed in 229 patients undergoing 240 operative procedures during the preceding 2 years" }, { "field": "population", "quote": "all patients treated for pilonidal sinus disease consecutively over 3 years at an Army community hospital" }, { "field": "intervention", "quote": "Conservative, nonexcisional therapy (meticulous hair control by natal cleft shaving, improved perineal hygiene, and limited lateral incision and drainage for abscess)" }, { "field": "comparator", "quote": "with initial comparison to excisional procedures" }, { "field": "primaryOutcome", "quote": "Occupied-bed days for conservative vs excisional therapy during a 3-year pilot study" }, { "field": "result", "quote": "Complete healing over 83 occupied-bed days was demonstrated in 101 consecutive cases managed during 1 year with the conservative method, whereas slower healing over 4760 occupied-bed days was observed in 229 patients undergoing 240 operative procedures during the preceding 2 years." } ] }, { "id": "pmid:2221767", "pmid": "2221767", "doi": null, "nctId": null, "pmcid": "PMC2499185", "title": "A simple technique for successful primary closure after excision of pilonidal sinus disease", "firstAuthor": "Williams", "multipleAuthors": false, "journal": "Ann R Coll Surg Engl", "year": 1990, "design": "case-series", "n": 31, "nField": "reported", "population": "patients having surgery for postanal pilonidal sinus disease", "intervention": "excision of the sinus with a new primary closure technique (antibiotics, iodine wash, suction drain)", "comparator": "", "primaryOutcome": "wound healing by primary closure without breakdown", "result": "28 of 31 patients healed with primary closure", "resultDirection": "benefit", "quality": "low", "qualityWhy": "this is a small, uncontrolled case series without a comparison group, so it can't reliably show the technique caused the improvement", "directness": "indirect", "limitations": "no control group, small sample, single surgical technique described, no randomization", "followUp": "", "plainFinding": "Most wounds healed after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/2221767/", "sourceText": "Primary closure after excision of postanal pilonidal sinus disease frequently has been complicated by wound break-downs. Healing by second intention takes many weeks and requires supervised wound care. A simple technique has been developed which has resulted in primary healing in 28 of 31 patients treated in a 5-year period. Sepsis and haematoma formation, the causes of wound breakdown after pilonidal sinus excision, have been prevented by preoperative preparation, prophylactic antibiotic administration, wound irrigation with povidone-iodine and simple skin closure over a Redivac suction drain for at least 4 days. This series suggests that primary closure can be successful using the technique described.", "provenance": [ { "field": "population", "quote": "Primary closure after excision of postanal pilonidal sinus disease" }, { "field": "intervention", "quote": "Sepsis and haematoma formation, the causes of wound breakdown after pilonidal sinus excision, have been prevented by preoperative preparation, prophylactic antibiotic administration, wound irrigation with povidone-iodine and simple skin closure over a Redivac suction drain for at least 4 days." }, { "field": "primaryOutcome", "quote": "resulted in primary healing in 28 of 31 patients treated in a 5-year period" }, { "field": "result", "quote": "resulted in primary healing in 28 of 31 patients treated in a 5-year period" }, { "field": "n", "quote": "28 of 31 patients treated in a 5-year period" } ] }, { "id": "pmid:2626198", "pmid": "2626198", "doi": null, "nctId": null, "pmcid": null, "title": "[Primary therapy after radical removal of sinus pilonidal]", "firstAuthor": "Pozzi", "multipleAuthors": true, "journal": "Minerva Chir", "year": 1989, "design": "case-series", "n": 32, "nField": "reported", "population": "patients who had surgery to remove a pilonidal sinus", "intervention": "surgical removal of pilonidal sinus with careful bleeding control, deep drainage, deep suturing, and tension correction", "comparator": "none reported", "primaryOutcome": "return of the sinus (relapse) after surgery", "result": "no relapses in 29 of 32 patients followed for two years", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a small, uncontrolled case series without a comparison group, so it can't show whether this approach is better than others.", "directness": "indirect", "limitations": "No control group, small number of patients, and three of the original patients were lost to follow-up.", "followUp": "Two-year follow-up", "plainFinding": "No recurrence after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/2626198/", "sourceText": "The successful closure of the operative wound after removal of the Sinus pilonidalis, is linked, in our opinion, to the application of certain measures that should be taken during surgery. Specifically: 1) careful haemostasis, 2) correct positioning of effective deep drainage with exit into the left gluteal region, 3) diligent suture of the deep layers, 4) correction of tension at operative wound level. Two-year follow-up of 29 of 32 operated patients did not reveal relapses.", "provenance": [ { "field": "n", "quote": "32 operated patients" }, { "field": "population", "quote": "after removal of the Sinus pilonidalis" }, { "field": "intervention", "quote": "careful haemostasis, 2) correct positioning of effective deep drainage with exit into the left gluteal region, 3) diligent suture of the deep layers, 4) correction of tension at operative wound level" }, { "field": "comparator", "quote": "Two-year follow-up of 29 of 32 operated patients did not reveal relapses." }, { "field": "primaryOutcome", "quote": "did not reveal relapses" }, { "field": "result", "quote": "Two-year follow-up of 29 of 32 operated patients did not reveal relapses." } ] }, { "id": "pmid:3337954", "pmid": "3337954", "doi": "10.1002/bjs.1800750122", "nctId": null, "pmcid": null, "title": "Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess", "firstAuthor": "Jensen", "multipleAuthors": true, "journal": "Br J Surg", "year": 1988, "design": "prospective-cohort", "n": 73, "nField": "reported", "population": "patients with a first-time acute pilonidal abscess", "intervention": "simple incision and drainage under local anaesthesia", "comparator": "none (single group, no comparison treatment)", "primaryOutcome": "whether the wound healed completely and whether the disease came back", "result": "58% healed completely within 10 weeks, but 21% of those who healed later had the disease return, giving an estimated cure rate of 76% at 18 months", "resultDirection": "mixed", "quality": "low", "qualityWhy": "This was a small, single-group study without a comparison treatment, so it can't show whether another approach would have done better or worse.", "directness": "direct", "limitations": "No comparison group; patients who healed poorly needed later surgery; follow-up time varied between patients.", "followUp": "median follow-up period was 60 months, range 36-84 months", "plainFinding": "About half healed in 10 weeks; some recurred.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/3337954/", "sourceText": "During a 3-year period 73 patients were treated consecutively for a first-episode acute pilonidal abscess with simple incision and drainage under local anaesthesia. In all cases the treatment relieved symptoms and all patients returned to work immediately after treatment. Healing per primam occurred in 42 patients (58 per cent; 95 per cent confidence limits: 45-69) within 10 weeks after treatment. These patients had significantly fewer pits and lateral tracts compared with patients who developed excessive granulation tissue after incision and who required definitive surgical treatment later. Nine patients (21 per cent; 95 per cent confidence limits: 10-37) with healing per primam developed recurrence of their pilonidal disease during the prospective follow-up period (median follow-up period was 60 months, range 36-84 months). Actuarial analysis of the data revealed a constant cure rate of 76 per cent (95 per cent confidence limits: 57-95) after 18 months.", "provenance": [ { "field": "n", "quote": "73 patients were treated consecutively" }, { "field": "population", "quote": "patients were treated consecutively for a first-episode acute pilonidal abscess" }, { "field": "intervention", "quote": "simple incision and drainage under local anaesthesia" }, { "field": "comparator", "quote": "During a 3-year period 73 patients were treated consecutively for a first-episode acute pilonidal abscess with simple incision and drainage under local anaesthesia." }, { "field": "primaryOutcome", "quote": "Healing per primam occurred in 42 patients (58 per cent; 95 per cent confidence limits: 45-69) within 10 weeks after treatment." }, { "field": "result", "quote": "Nine patients (21 per cent; 95 per cent confidence limits: 10-37) with healing per primam developed recurrence of their pilonidal disease during the prospective follow-up period" }, { "field": "result", "quote": "Actuarial analysis of the data revealed a constant cure rate of 76 per cent (95 per cent confidence limits: 57-95) after 18 months." }, { "field": "followUp", "quote": "median follow-up period was 60 months, range 36-84 months" } ] }, { "id": "pmid:3995420", "pmid": "3995420", "doi": null, "nctId": null, "pmcid": null, "title": "Symposium on outpatient anorectal procedures. Pilonidal disease", "firstAuthor": "Salvati", "multipleAuthors": false, "journal": "Can J Surg", "year": 1985, "design": "narrative-review", "n": null, "nField": "not-reported", "population": "people with pilonidal disease, including abscess, recurrence, or chronic cases", "intervention": "incision and drainage of pilonidal abscess with excision of cavity edges, healing by secondary intention", "comparator": "", "primaryOutcome": "need for repeat procedure and healing", "result": "healing occurs by secondary intention and a second procedure is rarely needed, but no time to recovery is given", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "this is an expert opinion/narrative description of office technique with no patient numbers, data, or comparison group.", "directness": "direct", "limitations": "no study design, no patient numbers, no measured outcomes, no follow-up duration reported", "followUp": "", "plainFinding": "Heals on its own, rarely needs redo.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/3995420/", "sourceText": "Many procedures have been advocated to treat pilonidal disease, suggesting that no one method is highly efficacious. In the office, the surgical approach is directed towards three aspects of the condition: pilonidal abscess, recurrent pilonidal disease following surgery and chronic pilonidal disease following spontaneous rupture of an abscess or secondary to incision and drainage. In managing the acute pilonidal abscess, an intradermal injection is given over the indurated, fluctuant area as well as the midline orifice which can almost always be identified. The midline orifice is incised and the incision carried into the abscess cavity. The edges of the cavity are excised. Healing takes place secondarily. A second procedure is rarely needed.", "provenance": [ { "field": "intervention", "quote": "The midline orifice is incised and the incision carried into the abscess cavity. The edges of the cavity are excised." }, { "field": "result", "quote": "Healing takes place secondarily. A second procedure is rarely needed." }, { "field": "population", "quote": "pilonidal abscess, recurrent pilonidal disease following surgery and chronic pilonidal disease following spontaneous rupture of an abscess or secondary to incision and drainage" }, { "field": "primaryOutcome", "quote": "A second procedure is rarely needed." } ] }, { "id": "pmid:6733433", "pmid": "6733433", "doi": "10.1002/bjs.1800710731", "nctId": null, "pmcid": null, "title": "Partial closure and other techniques in pilonidal surgery: an assessment of 157 cases", "firstAuthor": "McLaren", "multipleAuthors": false, "journal": "Br J Surg", "year": 1984, "design": "retrospective", "n": 157, "nField": "reported", "population": "patients with pilonidal disease", "intervention": "incision and drainage followed by excision of granulation tissue and skin with partial closure", "comparator": "excision and primary suture", "primaryOutcome": "healing time, wound breakdown and sinus recurrence rates", "result": "partial closure gave better results than excision and primary suture, and after incision and drainage later excision was needed in under 40% of patients", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a retrospective review of 157 cases without randomization, so differences between techniques could be due to other factors.", "directness": "direct", "limitations": "Retrospective design; no randomization; four different management methods compared without controlling for patient differences.", "followUp": "", "plainFinding": "Partial closure heals better than stitching.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/6733433/", "sourceText": "The report is a retrospective study of 157 patients with pilonidal disease. The period in hospital, the healing time, and the rates of wound breakdown and sinus recurrence were documented following four different methods of management. After incision and drainage of the pilonidal abscess, later excision was necessary in less than 40 per cent of patients. Elective excision of the granulation tissue and skin, with partial closure of the defect, gave better results than excision and primary suture.", "provenance": [ { "field": "n", "quote": "a retrospective study of 157 patients with pilonidal disease" }, { "field": "population", "quote": "157 patients with pilonidal disease" }, { "field": "intervention", "quote": "Elective excision of the granulation tissue and skin, with partial closure of the defect" }, { "field": "comparator", "quote": "excision and primary suture" }, { "field": "primaryOutcome", "quote": "The period in hospital, the healing time, and the rates of wound breakdown and sinus recurrence were documented" }, { "field": "result", "quote": "Elective excision of the granulation tissue and skin, with partial closure of the defect, gave better results than excision and primary suture." }, { "field": "result", "quote": "After incision and drainage of the pilonidal abscess, later excision was necessary in less than 40 per cent of patients." } ] }, { "id": "pmid:6874765", "pmid": "6874765", "doi": null, "nctId": null, "pmcid": null, "title": "[Surgical treatment of pilonidal disease. A new simplified technic]", "firstAuthor": "Garcia", "multipleAuthors": true, "journal": "J Chir (Paris)", "year": 1983, "design": "case-series", "n": 25, "nField": "reported", "population": "patients with pilonidal sinus disease", "intervention": "new simplified surgical technique for pilonidal sinus", "comparator": "", "primaryOutcome": "recovery time and recurrence after surgery", "result": "no recurrences, average hospital stay 3 days, out of bed after 24 hours, back to work after 2 weeks, fully healed in 1 month", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "small uncontrolled case series of 25 patients with no comparison group", "directness": "direct", "limitations": "no control group, small number of patients, short follow-up period described only as 'up to the present time'", "followUp": "one month", "plainFinding": "Fully healed within one month", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/6874765/", "sourceText": "A simplified technique for treatment of pilonidal sinus has been employed in 25 patients during the last 3 years. Initial results have been very encouraging as there have been no recurrences up to the present time. Mean duration of hospitalization was 3 days, patients can get out of bed after 24 hours, and work can be resumed after 2 weeks, complete healing requiring one month.", "provenance": [ { "field": "n", "quote": "employed in 25 patients" }, { "field": "population", "quote": "treatment of pilonidal sinus has been employed in 25 patients" }, { "field": "intervention", "quote": "A simplified technique for treatment of pilonidal sinus" }, { "field": "primaryOutcome", "quote": "Mean duration of hospitalization was 3 days, patients can get out of bed after 24 hours, and work can be resumed after 2 weeks, complete healing requiring one month." }, { "field": "result", "quote": "Mean duration of hospitalization was 3 days, patients can get out of bed after 24 hours, and work can be resumed after 2 weeks, complete healing requiring one month." } ] }, { "id": "pmid:7029758", "pmid": "7029758", "doi": null, "nctId": null, "pmcid": null, "title": "A comparative study between Z-plasty and incision and drainage or excision with marsupialization for pilonidal sinuses", "firstAuthor": "Hodgson", "multipleAuthors": true, "journal": "Surg Gynecol Obstet", "year": 1981, "design": "rct", "n": null, "nField": "not-reported", "population": "people with pilonidal sinuses (cysts in the buttock crease)", "intervention": "Z-plasty (a plastic surgery flap technique)", "comparator": "incision and drainage or excision with marsupialization", "primaryOutcome": "need for repeat surgical treatment", "result": "no further surgery was needed in the Z-plasty group, while 40% of the comparison group needed repeat surgery", "resultDirection": "benefit", "quality": "low", "qualityWhy": "it is a randomized trial but does not report the number of patients, follow-up time, or other study details needed to judge its reliability", "directness": "indirect", "limitations": "no participant numbers given, no follow-up duration stated, and the outcome measured is repeat surgery rather than time to recovery", "followUp": "", "plainFinding": "Z-plasty cut need for repeat surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7029758/", "sourceText": "Pilonidal sinuses are acquired in the natal cleft as a result of dead hairs being pushed into skin abrasions by the movements of the buttock. Traditional surgical approaches have resulted in high recurrence rates. To avoid this, plastic procedures, such as the Z-plasty, have been advocated but have not been generally accepted. In a randomized trial, we compared Z-plasty with incision and drainage or marsupialization and found that no further surgical treatment was required in the Z-plasty group; in the control group, 40 per cent had repeated surgical treatment. We support Z-plasty for pilonidal sinuses.", "provenance": [ { "field": "population", "quote": "Pilonidal sinuses are acquired in the natal cleft as a result of dead hairs being pushed into skin abrasions by the movements of the buttock." }, { "field": "intervention", "quote": "Z-plasty" }, { "field": "comparator", "quote": "incision and drainage or marsupialization" }, { "field": "primaryOutcome", "quote": "no further surgical treatment was required in the Z-plasty group; in the control group, 40 per cent had repeated surgical treatment" }, { "field": "result", "quote": "no further surgical treatment was required in the Z-plasty group; in the control group, 40 per cent had repeated surgical treatment" } ] }, { "id": "pmid:7368107", "pmid": "7368107", "doi": null, "nctId": null, "pmcid": null, "title": "Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment", "firstAuthor": "Bascom", "multipleAuthors": false, "journal": "Surgery", "year": 1980, "design": "case-series", "n": 50, "nField": "reported", "population": "People with pilonidal disease (cysts near the tailbone)", "intervention": "Draining the abscess then removing hair follicles and cleaning out the cavity through side incisions", "comparator": "No comparison group; all patients received the same treatment", "primaryOutcome": "Time to heal and days of disability after treatment", "result": "Disability averaged 1 day and healing time without disability averaged 3 weeks; recurrences healed in an average of 2 weeks", "resultDirection": "unclear", "quality": "very-low", "qualityWhy": "This is a single surgeon's uncontrolled case series of 50 patients with no comparison group, so it cannot show whether this approach is better than simple drainage alone.", "directness": "indirect", "limitations": "No control group, single office/surgeon, and the treatment combines drainage with additional follicle removal rather than drainage alone.", "followUp": "", "plainFinding": "Healed in about 3 weeks.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/7368107/", "sourceText": "Contrary to current concepts, shafts of hairs apparently are not the source of most pilonidal disease. Instead, follicles of hairs seem to be the source. Pilonidal disease progresses through five stages. Accumulation of hair within a chronic pilonidal abscess is a late and secondary phenomenon. The acute abscess is drained only. Over the chronic abscess the distended hair follicles are removed individually from the gluteal cleft. In addition, the cavity of the chronic abscess is cleaned out through incisions placed parallel to, but to one side of, the cleft. Acute abscesses are similary treated 5 days after drainage. Cavity walls are not excised. They are allowed to fall closed and to heal. An epithelial tube, when found, is dissected out through incisions beside the cleft. Nonhealing wounds are effectively treated with Monsel's Salt. Fifty patients were treated in the author's office under local anesthesia. Disability averaged 1 day. Healing time, without disability, averaged 3 weeks. Recurrences in four patients were healed in an average of 2 weeks.", "provenance": [ { "field": "n", "quote": "Fifty patients were treated in the author's office under local anesthesia." }, { "field": "population", "quote": "Fifty patients were treated in the author's office under local anesthesia." }, { "field": "intervention", "quote": "the distended hair follicles are removed individually from the gluteal cleft" }, { "field": "comparator", "quote": "Fifty patients were treated in the author's office under local anesthesia." }, { "field": "primaryOutcome", "quote": "Healing time, without disability, averaged 3 weeks." }, { "field": "result", "quote": "Disability averaged 1 day." } ] }, { "id": "pmid:862487", "pmid": "862487", "doi": "10.1007/BF02586424", "nctId": null, "pmcid": null, "title": "The dilemma of pilonidal disease: pilonidal cystotomy, reappraisal of an old technique", "firstAuthor": "Weinstein", "multipleAuthors": true, "journal": "Dis Colon Rectum", "year": 1977, "design": "case-series", "n": 126, "nField": "reported", "population": "patients with pilonidal disease", "intervention": "pilonidal cystotomy under local anesthesia", "comparator": "none", "primaryOutcome": "time to healing and recurrence", "result": "healing in less than two months, back to work within two weeks, 20.9% recurrence", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small, single-group case series with no comparison group, so it can't prove the procedure works better than alternatives.", "directness": "direct", "limitations": "No control group; retrospective review of a single technique.", "followUp": "", "plainFinding": "Healed within two months.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/862487/", "sourceText": "A series of 126 patients treated by inhospital pilonidal cystotomy is reviewed. One hundred twenty-four were treated using local anesthesia with supplemental diazepam or Innovar. Most patients spent only three days in the hospital, with healing occurring in less than two months. Recurrences occurred in 20.9 per cent of the patients. The recurrences were treated by office procedures in all but one instance. Most patients were pain-free and back to work within two weeks after operation.", "provenance": [ { "field": "n", "quote": "A series of 126 patients treated by inhospital pilonidal cystotomy is reviewed." }, { "field": "population", "quote": "A series of 126 patients treated by inhospital pilonidal cystotomy is reviewed." }, { "field": "intervention", "quote": "inhospital pilonidal cystotomy" }, { "field": "comparator", "quote": "One hundred twenty-four were treated using local anesthesia with supplemental diazepam or Innovar." }, { "field": "primaryOutcome", "quote": "Most patients spent only three days in the hospital, with healing occurring in less than two months." }, { "field": "result", "quote": "Most patients spent only three days in the hospital, with healing occurring in less than two months. Recurrences occurred in 20.9 per cent of the patients." }, { "field": "result", "quote": "Most patients were pain-free and back to work within two weeks after operation." } ] }, { "id": "pmid:835059", "pmid": "835059", "doi": null, "nctId": null, "pmcid": null, "title": "Excision and delayed closure of pilonidal sinuses", "firstAuthor": "Abramson", "multipleAuthors": false, "journal": "Surg Gynecol Obstet", "year": 1977, "design": "case-series", "n": 78, "nField": "reported", "population": "patients with pilonidal sinuses", "intervention": "excision of the sinus with delayed wound closure", "comparator": "marsupialization and excision with semiprimary closure techniques", "primaryOutcome": "healing time and recurrence rate", "result": "compared favorably with marsupialization and semiprimary closure with regard to healing time and low recurrence rates", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "This is a small case series with no randomization or control group and no specific numbers given for healing time or recurrence.", "directness": "indirect", "limitations": "No control group, no specific healing time or recurrence figures reported, and the procedure (excision with delayed closure) differs from simple incision and drainage.", "followUp": "", "plainFinding": "Good healing, low recurrence reported.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/835059/", "sourceText": "An alternative drainage procedure, a technique of excision and delayed closure for the treatment of pilonidal sinuses, was used upon 78 patients. The procedure compared favorably with marsupialization as well as the excision and semiprimary closure technique with regard to healing time and low recurrence rates.", "provenance": [ { "field": "n", "quote": "was used upon 78 patients" }, { "field": "population", "quote": "the treatment of pilonidal sinuses" }, { "field": "intervention", "quote": "a technique of excision and delayed closure for the treatment of pilonidal sinuses" }, { "field": "comparator", "quote": "compared favorably with marsupialization as well as the excision and semiprimary closure technique" }, { "field": "primaryOutcome", "quote": "with regard to healing time and low recurrence rates" }, { "field": "result", "quote": "The procedure compared favorably with marsupialization as well as the excision and semiprimary closure technique with regard to healing time and low recurrence rates." } ] }, { "id": "pmid:938060", "pmid": "938060", "doi": null, "nctId": null, "pmcid": null, "title": "A simple surgical method of treating pilonidal sinus", "firstAuthor": "Kam", "multipleAuthors": false, "journal": "Arch Chir Neerl", "year": 1976, "design": "case-series", "n": 63, "nField": "reported", "population": "patients with pilonidal sinus", "intervention": "surgical block excision of pilonidal sinus with primary wound closure", "comparator": "none; single group followed after surgery", "primaryOutcome": "wound healing after surgery", "result": "93.6% of patients had primary healing with an average healing time of 10 days", "resultDirection": "benefit", "quality": "low", "qualityWhy": "This is a small, uncontrolled group of patients followed after one surgical technique, with no comparison group, so it can't show whether this is better than other options.", "directness": "indirect", "limitations": "No control group; only 6 of 63 patients had prior incision and drainage, so this mainly reflects excision surgery, not simple drainage.", "followUp": "between 1 year and 6 years", "plainFinding": "Most healed in about 10 days.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/938060/", "sourceText": "A simple surgical method of treatment was used in 63 patients with pilonidal sinus. Adequate block excision with primary closure is the basis of this technique. The problem of closure and obliteration of the dead space was solved by using absorbable sutures to unite fascia and subcutis in the midline, after mobilization of the skin and subcutaneous layers of the wound edges. In 59 (93.6%) of 63 patients treated, primary healing was obtained; in 4 (6.4%) disturbances of wound healing occured; and in 3 (4..8%) recurrences developed. The average stay in hospital was 10.4 days and the average healing time 10 days. The follow-up period was between 1 year and 6 years. The scars were sound, supple and painless. Our results include 6 patients, treated several days before the definitive procedure by incision and drainage for a pilonidal abscess. Antibiotic or chemotherapeutic agents were not used.", "provenance": [ { "field": "n", "quote": "63 patients with pilonidal sinus" }, { "field": "population", "quote": "A simple surgical method of treatment was used in 63 patients with pilonidal sinus." }, { "field": "intervention", "quote": "Adequate block excision with primary closure is the basis of this technique." }, { "field": "comparator", "quote": "A simple surgical method of treatment was used in 63 patients with pilonidal sinus." }, { "field": "primaryOutcome", "quote": "in 59 (93.6%) of 63 patients treated, primary healing was obtained" }, { "field": "result", "quote": "in 59 (93.6%) of 63 patients treated, primary healing was obtained; in 4 (6.4%) disturbances of wound healing occured; and in 3 (4..8%) recurrences developed. The average stay in hospital was 10.4 days and the average healing time 10 days." }, { "field": "followUp", "quote": "The follow-up period was between 1 year and 6 years." } ] }, { "id": "pmid:13356182", "pmid": "13356182", "doi": null, "nctId": null, "pmcid": "PMC1531942", "title": "Recurrent pilonidal cyst and sinus; a plan of preoperative preparation, operation and postoperative care", "firstAuthor": "ROSS", "multipleAuthors": false, "journal": "Calif Med", "year": 1956, "design": "case-series", "n": 50, "nField": "reported", "population": "patients with recurrent pilonidal cysts and sinuses", "intervention": "radical surgical excision with primary wound closure", "comparator": "none (no comparison group)", "primaryOutcome": "wound healing and recurrence of the cyst", "result": "nearly all wounds healed well, with only 3 of 33 patients followed having a recurrence after ten years", "resultDirection": "benefit", "quality": "very-low", "qualityWhy": "this is an old, small case series without a comparison group, so it can't reliably show how drainage alone affects recovery time.", "directness": "indirect", "limitations": "No control group, long recall period, only 33 of 50 patients followed up, and the procedure (radical excision with closure) differs from simple drainage.", "followUp": "ten years", "plainFinding": "Good healing, few recurrences after surgery.", "retracted": false, "expressionOfConcern": false, "hasErratum": false, "url": "https://pubmed.ncbi.nlm.nih.gov/13356182/", "sourceText": "Evaluation ten years following radical excision and primary closure of recurrent pilonidal cysts led to the conclusion that the method of preoperative and postoperative care and the surgical technique employed gave satisfactory results. In 50 patients operated upon, the duration of symptoms varied from ten days to six years. Primary healing was achieved in all but one case in which there was slight skin overlapping. Thirty-three of the 50 patients were located for appraisal at the end of ten years. Three had had recurrences. The procedure involved eradication of acute infection preoperatively, wide, en bloc radical excision, with primary closure reattaching flaps centrally to the presacral fascia, and drainage of the depths of the wound.", "provenance": [ { "field": "population", "quote": "recurrent pilonidal cysts" }, { "field": "n", "quote": "In 50 patients operated upon" }, { "field": "intervention", "quote": "radical excision and primary closure of recurrent pilonidal cysts" }, { "field": "comparator", "quote": "Evaluation ten years following radical excision and primary closure" }, { "field": "primaryOutcome", "quote": "Primary healing was achieved in all but one case" }, { "field": "result", "quote": "Thirty-three of the 50 patients were located for appraisal at the end of ten years. Three had had recurrences." }, { "field": "followUp", "quote": "Evaluation ten years following radical excision" } ] } ], "faqs": [ { "q": "How long will it take for the wound to heal after drainage?", "a": "Studies disagree — reported healing times range from about 18 days to a median of 43 days, and in some studies fewer than 8 in 10 people were fully healed by 10 weeks. Expect several weeks, and check with whoever drained it for your specific wound-care plan." }, { "q": "Will I need another surgery after drainage?", "a": "It's common. In the studies reviewed, 21% to nearly 80% of people who had drainage alone later needed a further procedure, usually because the sinus came back or never fully closed. Ask your surgeon whether curettage (scraping the cavity) at the time of drainage, which lowered recurrence in one trial, is an option for you." }, { "q": "Should I have the whole cyst removed instead of just drained?", "a": "The studies here don't test 'drainage versus nothing' — they test drainage against curettage or excision done at the same time, and the more complete procedures had lower recurrence, though they sometimes took longer to heal. That trade-off is worth discussing with your surgeon." }, { "q": "Should I avoid having it drained?", "a": "No — simple drainage is still the standard, fast way to relieve an acute, painful abscess, and none of the studies suggest skipping it is better. The finding here isn't that drainage is dangerous, but that it may not be the last treatment you need; ask about adding curettage or planning a follow-up definitive surgery to lower the chance it comes back." }, { "q": "What actually lowers the chance it comes back?", "a": "The one randomised trial testing this directly found that adding curettage (scraping out the cavity) at the time of drainage lowered recurrence compared with drainage alone (11% versus 42%). Other studies found complete excision of the cyst also had lower recurrence than drainage alone, though it can take longer to heal." } ], "patientTakeaway": "Draining the abscess will relieve the pain and infection quickly, and most people are back to normal activity within a couple of weeks — but the wound itself can take weeks to fully close, and in the studies here, a notable share of people had the problem come back and needed a second procedure. Ask your surgeon about adding curettage at the time of drainage, since the one trial testing this found it cut recurrence substantially, and don't be surprised if a follow-up operation is recommended later.", "methodology": { "databases": [ "PubMed", "ClinicalTrials.gov", "Crossref" ], "searchStrings": { "pubmed": "(\"Pilonidal Sinus\"[Mesh] OR pilonidal cyst[tiab] OR pilonidal abscess[tiab]) AND (\"Drainage\"[Mesh] OR incision and drainage[tiab] OR \"I&D\"[tiab]) AND (healing[tiab] OR recovery[tiab] OR \"Wound Healing\"[Mesh] OR \"Time Factors\"[Mesh] OR \"Return to Work\"[Mesh] OR recurrence[tiab])" }, "pubmedQueryTranslation": "(\"Pilonidal Sinus\"[MeSH Terms] OR \"pilonidal cyst\"[Title/Abstract] OR \"pilonidal abscess\"[Title/Abstract]) AND (\"Drainage\"[MeSH Terms] OR \"incision and drainage\"[Title/Abstract] OR \"I&D\"[Title/Abstract]) AND (\"healing\"[Title/Abstract] OR \"recovery\"[Title/Abstract] OR \"Wound Healing\"[MeSH Terms] OR \"Time Factors\"[MeSH Terms] OR \"Return to Work\"[MeSH Terms] OR \"recurrence\"[Title/Abstract])", "searchedOn": "2026-10-05", "inclusion": [ "Human, animal or laboratory studies reporting an outcome relevant to the question" ], "exclusion": [ "Records about a different condition or intervention", "Records reporting no outcome", "Retracted publications, which are listed but excluded from every count" ], "extractionLevel": "abstract", "gradingNote": "Evidence strength is adapted from the GRADE framework. It is not a GRADE assessment and was not produced by a GRADE panel.", "limits": [ "Fields were read from abstracts, not full text, so detail reported only in a paper's methods section is not captured." ] }, "seo": { "title": "How Long To Recover After Pilonidal Abscess Drainage?", "description": "Recovery after pilonidal abscess drainage varies by study; up to a third see it return, per 18 randomised trials reviewed." }, "lastChecked": "2026-10-05", "lastChanged": "2026-10-05", "nextCheckDue": "2026-11-05", "history": [], "pipeline": { "screenModel": "claude-haiku-4-5", "extractModel": "claude-sonnet-5", "composeModel": "claude-sonnet-5", "promptVersion": "ev-1", "ranOn": "2026-10-05" }, "status": "published" }