Abstract

Purpose: Numerous definitive surgical techniques exist for the treatment of pilonidal disease with varied recurrence rates and wound complications. Due to the wide array of techniques and lack of consensus on the best approach, we proposed to study our experience treating pilonidal disease in adolescents and young adults.Methods: A retrospective analysis was conducted of patients 10–24 years old treated at a tertiary medical center from 2011 to 2016. Data including demographics, management, and outcomes were collected and analyzed. Primary outcome was recurrence of disease.Results: One hundred and thirty three patients with pilonidal disease underwent operative management. Fifty one percent underwent primary closure and 49% healed by secondary intention with no significant difference in recurrence rates (primary 18%, secondary 11%; p = 0.3245). Secondary healing patients had significantly lower wound complication rates (primary 51%, secondary 23%; p = 0.0012). After accounting for sex, race, weight, and operative technique, age was predictive of disease recurrence with an adjusted odds ratio (OR) of 0.706 (0.560–0.888; p = 0.003). Age and sex were both predictive of wound complications. Older patients had decreased risk of wound complication (adjusted OR 0.806, 95% CI 0.684–0.951; p = 0.0105), and male patients had increased risk of wound complication (adjusted OR 2.902, 95% CI 1.001–8.409; p = 0.0497).Conclusion: In summary, there is no significant difference in the recurrence rates between operative techniques for pilonidal disease. Older patients have decreased risk of recurrence following intervention. Wound complication rates are lower in patients undergoing secondary healing, though this may be better explained by differences in age and sex. Additional research investigating newer, minimally-invasive techniques needs to be pursued.

Highlights

  • Pilonidal sinus disease is a chronic and recurring condition which occurs at the natal cleft

  • The results of this study indicate that while the overall recurrence rates of pilonidal disease are similar among primary and secondary closure techniques, wound complication rates were significantly higher among primary closure groups compared to secondary healing groups

  • The study found no difference in recurrence between the secondary healing and primary closure groups

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Summary

Introduction

Pilonidal sinus disease is a chronic and recurring condition which occurs at the natal cleft. The ideal treatment for chronic pilonidal sinus should have a low incidence of recurrence and complication while minimizing pain and hospital stay [7]. There are many different surgical treatments available: excision with primary midline closure, excision with flap or off-midline closure, and excision with secondary or open healing, including marsupialization. These methods vary on a wide range of factors such as recurrence, healing time, and infection rates [8,9,10]. There is notably a trend toward less invasive procedures, such as video-assisted ablation, due to recurrence and complication associated with open operative procedures [11,12,13,14]

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