Primary Midline Closure Research Articles

Surgical Treatment of Uncomplicated Pilonidal Sinus with the Simple Closed Technique - New Findings of Pilonidal Sinus Treatment from Albania.

Dear Editor,
 Concerning the article of Bollano E et al. “Surgical treatment of uncomplicated Pilonidal Sinus with a simple closed technique” has been gathering our attention. In this LTE, we would like to critically discuss some of the author's statements. Firstly, the stated pathophysiology of PSD is an outdated theory. Furthermore, primary midline closure, as postulated by the author, is not the surgical procedure of first choice, as several large reviews have shown.
 The letter discusses the rationale behind adopting the simple closed technique, highlighting its efficacy and potential advantages. By presenting data from our experiences in Albania, we aim to contribute valuable insights to the global discourse on pilonidal sinus treatment.
 This letter is a noteworthy addition to AJTES, offering fresh insights into the treatment landscape of pilonidal sinus. We trust the editorial team will find the content aligned with the journal's objectives and scope.
 Your consideration of this submission is highly appreciated, and we look forward to the possibility of contributing to the journal's ongoing dialogue on innovative surgical approaches.

Pilonidal sinus disease: a 25-year experience and long-term results of different surgical techniques

Summary Background The incidence of pilonidal disease is increasing. The choice of surgical approach differs between surgeons and countries. With better understanding of the etiology of the disease, there is a shift toward more successful concepts of treatment. In many cases, management can be challenging owing to the number of previous failed operations. Objective The aim of this retrospective single-center cohort study was to compare recurrence rates and postoperative wound complications between five treatment arms. Methods A total of 299 patients who underwent surgery for pilonidal disease between November 1994 and May 2019 were included. Primary endpoint was time to recurrence, secondary endpoint was wound care complication rate. Results Median follow-up was 85.8 months in 286 patients. An overall recurrence rate of 16.1% was observed at 24 months, 21.4% at 60 months, and 47.4% at 303 months; 24 months postoperatively, there was a range from 10.5% for excision with primary midline closure to 30.0% for the Bascom I procedure. Recurrence in excision with primary midline closure was 71.8% 268 months postoperatively. No statistically significant differences were observed between the five groups (p = 0.54). The highest prevalence of wound complications (46.3%) was in excision with midline closure. Cox regression showed that previous pilonidal operations are an independent prognostic factor for developing recurrence (p = 0.006). Multivariate logistic regression revealed that previous pilonidal operations have a significant predictive value for developing postoperative wound complications (odds ratio = 4.04, 95% confidence interval [1.61–10.18]; p = 0.003). Conclusion In order to improve surgical outcomes, emphasis should be given to adoption of techniques with high success rates.

Limberg Flap Versus Primary Midline Wound Closure in Treatment of Chronic Pilonidal Sinus Disease

Objective: Current study aims to compare the Limberg flap technique with primary midline wound closure to treat the chronic pilonidal sinus disease. Study design: A comparative study was done in Surgery Department Sir Ganga Ram Hospital Lahore from January 2020 to September 2021 Method: The sample size for the study is 60 patients who were regularly visiting the hospital due to PS disease. All the patients were divided into two groups A and B. Group A had 30 patients treated with the Limberg flap method and group B had 30 patients treated with primary midline wound closure. Before starting the treatment a brief description of the treatment was given to all patients and consent was signed from all participants. The final decision for treatment was decided by the team of senior surgeons as well as with help of the patient's own choice. Limberg flap and primary midline wound closure (PMC) were applied to patients who regularly followed the instruction for chronic pilonidal sinus treatment. Primary midline closure was applied on patients who had a cosmetic concern and did not have a recurrence problem. Results: Total 60 patients were divided into two groups, Group A (Limberg flap) had 30 patients in which 25 (83%) were males and 5 (16.6%) females. The mean age for this group was 25 ± 5.00 years. The patients without a previous history of pilonidal sinus disease (primary case) was 17 (56.6%) and the recurrence case was 13 (14.3%). Group B (primary midline wound closure) had 30 patients in which 18 (60%) were males and 12 (40%) females. The mean age for this group was 28 ± 3.00 years. The patient without a previous history of pilonidal sinus disease (primary case) was 28 (93.3%) and the recurrence case was 2 (6.6%). The comparison of 3rd-week outcomes shows that in group A 25 (83,3%) patients had painless walking, 23 (76.6%) patients start their routine work and 26 (86.6%) patients had treatment satisfaction. In group B 21 (70%) patients reported painless walking, 18 (60%) patients started their routine activity and 22 (73.3%) patients shows satisfaction with treatment. Conclusion: Hence we concluded that a better improvement percentage was measured high in group A (Limberg flap) than group B (PMC). Therefore limberg flap is better technique to treat the chronic pilonidal sinus disease. Keywords: chronic Pilonidal Sinus, primary midline wound closure (PMC), Limberg flap

Comparison of Primary Midline Closure and Open Surgery for Sacrococcygeal Pilonidal Sinus: A Retrospective Study

Background: Sacrococcygeal Pilonidal sinus (SPNS) isa common problem has a variable presentation and many surgical techniques for treatment. Still, there is controversy about the best method of surgery, because of notable rates of recurrence. Objective: The aim is to clarify the better, cost-effective and less painful method for treating patients having SPNS. Methods: This is a retrospective study of 119 patients with SPNS, treated by two different surgical methods: group A (69 patients) treated with open surgery and group B (50 patients) treated by primary midline closure. The patients followed for 2 years. Comparison between the two groups was done, for post-operative complications and recurrence. The data were analyzed using of Statistical Package for Social Science (SPSS) version 21. Chi square used to determine association between variables. P value < 0.05 is regarded statistically significant. Results: From 119 patients: Group A (69 cases) underwent open surgery and group B (50 cases) had primary closure. Postoperative infection was (5.9%), bleeding (2.5%), scar fissuring (5.9%) and chronic pain (3.4%). Recurrence found in 6 patients (5%); 2(2.9%) in Group A and 4(8%) in Group B. Conclusions: The open method needs multiple dressings which are coasty and painful, longer healing time and may be complicated by scar fissuring, but of lower recurrent and infection. The closed method is preferablefor patient's comfort, and it is costeffectiveness.

Abdominal Wall Expanding System. Intraoperative Abdominal Wall Expansion as a Technique to Repair Giant Incisional Hernia and Laparostoma. New and Long-Term Results From a Three-Center Feasibility Study.

The abdominal wall expanding system (AWEX) was first applied in 2012 and published in 2017. This novel technique was developed to reconstruct complex incisional hernias and residual skin-grafted laparostoma after treatment of an open abdomen, when primary midline closure was impossible. The main aim was the anatomical reconstruction of the abdominal wall and the avoidance of dissecting techniques (component separation). Between 2012 and 2019, 33 patients underwent AWEX hernia repair in three certified hernia centers. The retracted abdominal wall was stretched with the AWEX system intraoperatively for approximately 30min. Hernia size was measured preoperatively, on CT, and intraoperatively. The gain in length on the lateral abdominal wall (decrease in width of the defect) after stretching and any residual midline gap were determined in the OR. 33 patients underwent AWEX procedures. Six cases were evaluated separately because of additional procedures (TAR, four cases) and preoperative application of botulinum toxin (two cases). The median (95% confidence interval) measured width of hernia defects was 13 (12-16) cm, the median gain in length on the lateral abdominal wall was 12 (10-15) cm. After median follow-up of 29 (12-54) months, one recurrence from the broken mesh was observed. No method-related complications occurred. Based on the 2017 and current results, the AWEX system represents an alternative or supplemental procedure to current techniques for complex abdominal wall reconstruction. The system proved again to be time-saving, safe, effective, and easy to learn. Further studies with enhanced technology are in progress.

Comparative Study in Surgical Management of the Pilonidal Sinus Disease

The objective: the current study conducted to assessment the recurrence rate of Pilonidal sinus.Materials &amp; Methods: This retrospective study that shows all the cases of Pilonidal sinus treated in theKhanaqin General Hospital and Jalawla General Hospital at period between April 2016 to September of2019. The number of patients is 200, including 48 women and 152 men, with ages ranging from 19 to 50years.Results: 200 Pilonidal sinus patients were participated in this current study. The recurrence rate aftersurgery reached 13(6.5%) from all patients. The patients who used in present study include male 152(76%)and female 48(24%). According to Chronicity, the present results demonstrate 73 (36.5%) cases as acutedisease and 127 (63.5%) as chronic disease. 79 patients who suffering from acute disease were lay open andcollection drainage. On the other hand, 121 patients who were suffering from chronic disease treated withsinus excisional procedures and primary midline closure.

Pilonidal Cyst Excision: Primary Midline Closure with versus without Closed Incision Negative Pressure Therapy.

Background:Pilonidal cysts are a painful condition that primarily affect young adult men. In the literature, numerous operative techniques for resolving pilonidal cysts are described, with variable outcomes. The objective of this study was to compare primarily closed midline incisions managed with or without the use of closed incision negative pressure therapy after pilonidal cyst excision.Methods:Twenty-one patients underwent excision and midline primary closure. Postoperative care composed of closed incisional negative pressure therapy (study group; n = 10) or gauze dressings (control group; n = 11). In both groups, the sutures were partially removed on day 14 and completely removed on day 21. Compared outcomes included the duration of hospitalization, pain on the day of surgical procedure, and on postoperative day 7, and time-to-healing.Results:The median hospital stay was about 9 hours and 23 hours in the study and control groups, respectively (P < 0.05). The median pain scores on the day of operation were 1.20/10 in the study group and 3.36/10 in the control group (P < 0.05). On day 7, study group showed median pain score 0.9/10 and control group showed 2.63/10 (P < 0.05). The mean healing time was 23.8 and 57.9 days in the ciNPT group and gauze group, respectively (P < 0.05).Conclusion:These outcomes supported the incorporation of closed incision negative pressure therapy into our surgical treatment protocol for pilonidal cysts.

Comparative Study between Excision with Primary Closure versus Flap Reconstruction in Management of Sacrococcygeal Pilonidal Sinus

Introduction and aim: Pilonidal sinus (PNS) is a common inflammatory condition of the gluteal region. Different methods were introduced for treatment. However, recurrence is still a significant problem after surgery and different approaches were described to lower the recurrence rate. But controversy exist regarding the standard surgical intervention. The current work aimed to compare between excision with off midline primary closure versus Limberg flap procedure in the treatment of sacrococcygeal PNS.&#x0D; Methodology: Sixty patients with PNS were included and divided into two equal groups, the first for primary midline excision with closure, and the second treated by Limberg flap. Patients were assessed by clinical evaluation and after surgery, the recurrence rate was documented through the first year. In addition, complications rate and times to restore the normal daily activities were documented and compared between groups.&#x0D; Results: Both groups were comparable regarding all preoperative variables. The operative time was significantly short among group I than group II (31.6± 6.5 vs 51.6± 6.4 minutes). The duration of hospital stay, time to return to work, drainage amount, time to stitch removal, time to walk pain-free and time to painless toilet seat were significantly shorter in group I. However, cosmetic score was significantly higher in group I than group II. Finally, the recurrence rate was significantly higher in group I than group II (20.0% vs 0.0%). The recurrence was significantly associated with hairy skin, positive family history, diabetes mellitus, higher BMI, and history of previous PNS.&#x0D; Conclusion: Primary midline closure of PNS is superior than the Limberg flap in operative time and times to return to normal daily activities. However, it had a higher recurrence rate. Thus, Limberg flap is advocated for PNS.

Comparison of Karydakis Flap versus Tension-Free Primary Midline Closure in Pilonidal Sinus Treatment

Comparison of Karydakis Flap versus Tension-Free Primary Midline Closure in Pilonidal Sinus Treatment

Outcome of Excision with Primary Midline Closure for Sacrococcygeal Pilonidal Sinus Disease

Sacrococcygeal Pilonidal sinus disease is common chronic inflammatory disease affecting chiefly young adult male . It cause much discomfort and morbidity and affect negatively the quality of life of patients. There are various techniques of surgical treatment for the chronic sinuses but still there is no gold standard one. The aim of this study to report our experience with excision and midline closure technique of chronic Sacrococcygeal Pilonidal sinus disease and to identify the outcome of the procedure for postoperative wound complications and recurrence rate. This is a retrospective study with telephone contact and review of 36 patients operated for Sacrococcygeal pilonidal sinus disease from January 2011 through January 2016 under care of one consultant surgeon (the Author) in Public and Private Hospitals in Rania, Sulaimani, Iraq. Inclusion criteria was all patients with chronic midline located sinuses without evidence of acute inflammation. Exclusion criteria was all infected ,off midline located sinuses and recurrent sinuses. Elliptical Excision of the sinuses with primary midline closure over a vacuum drainage performed. End point of this study was rate of wound complications and recurrence of sinus. Thirty six patients with median age 22 years (range 14-40) with 24/12 male /female ratio. Median follow up was 24 months (12 - 66 months), the recurrence occurred in 3/36 ( 8.3%) patients at a median of 12 months (range 5 - 48), failure of treatment in 5/36 (13.9%) patients, and postoperative wound complications was seen in 5/36 ( 13.9%) patients. In the conclusion, excision and primary midline closure is simple, effective and preferable procedure for management of uncomplicated Sacrococcygeal pilonidal sinus disease associated with early wound healing and low rate of postoperative wound complications and recurrence rate.

Combining anterior and posterior component separation for extreme cases of abdominal wall reconstruction

PurposeThe closure of midline in abdominal wall incisional hernias is an essential principle. In some exceptional circumstances, despite adequate component separation techniques, this midline closure cannot be achieved. This study aims to review the results of using both anterior and component separation in these exceptional cases.MethodsWe reviewed our experience using the combination of both anterior and posterior component separation in the attempt to close the midline. Our first step was to perform a TAR and a complete extensive dissection of the retromuscular preperitoneal plane developed laterally as far as the posterior axillary line. When the closure of midline was not possible, an external oblique release was made. A retromuscular preperitoneal reinforcement was made with the combination of an absorbable mesh and a 50 × 50 polypropylene mesh.ResultsTwelve patients underwent anterior and posterior component separation. The mean hernia width was 23.5 ± 5. The majority were classified as severe complex incisional hernia and had previous attempts of repair. After a mean follow-up of 27 months (range 8–45), no case of recurrence was registered. Only one patient (8.33%) presented with an asymptomatic bulging in the follow-up. European Hernia Society’s quality of life scores showed a significant improvement at 2 years postoperatively in the three domains: pain (p = 0.01), restrictions (p = 0.04) and cosmetic (p = 0.01).ConclusionsThe combination of posterior and anterior component separation can effectively treat massive and challenging cases of abdominal wall reconstruction in which the primary midline closure is impossible to achieve despite appropriate optimization of surgery.

EFFECTIVENESS OF GLUTEUS MAXIMUS FASCIA PLASTY FLAP FOR CLOSURE OF WOUND IN SURGICAL TREATMENT OF PILONIDAL DISEASE

Aim: to compare short- and long-term results of primary midline closure and gluteus maximus fascia flap plasty after pilonidal sinus excision. Method: retrospective analysis included consecutive patients who had primary and recurrent pilonidal sinus excised. Patients with gluteus maximus fascia flap plasty formed 1st group, patients with primary midline closure formed 2nd group. Gluteus maximus fascia flap plasty technique: (i) separation in lateral directions of both gluteus maximus fascia from muscle and subcutaneous tissue; (ii) mobilised fascia flaps are brought together to midline and sutured; (iii) subcutaneous fat and skin sutured. Results: 60 patients operated in 2007-2016 were included: 28 in 1st group, 32 in 2nd group. Groups 1 and 2 didn’t differ in operation time (41.9±4.0 and 37.3±3.1 min, p=0.4), blood loss (6.9±0.5 and 8.3±1.6 ml, p=0.2), draining rate (7.1% and 12.5%, p=0.5), hospital stay (11.8±1.3 and 9.1±1.0 days, p=0.1), time to complete wound epithelialization (1.2±0.2 and 1.5±0.4 months, p=0.37). Mean follow-up was 20.7±3.2 and 53.8±6.5 months respectively. Recurrence rate was significantly lower in gluteus maximus fascia flap plasty group (3.6%) than in the 2nd group (21.9%, p=0.04). Conclusion: gluteus maximus fascia flap plasty after pilonidal sinus excision is feasible, doesn’t increase postoperative complications rate and leads to a lower recurrence rate compared to midline closure.

Pilonidal Sinus—Plenty of Literature yet Lack of Direction: A Pooled Analysis

A systematic analysis was conducted to compare various surgical treatment modalities and evaluate the short- and long-term outcomes in the management of sacrococcygeal pilonidal disease. Pilonidal sinus is a common and debilitating condition often requiring a surgical approach to treatment, of which many are available. Despite numerous treatment methods, no universal decision has been made as to the most efficient and effective surgical treatment. All randomized control trials published between January 1, 2003 and January 8, 2013 were accessed. Interventions included classic and modified Limberg flap, Karydakis flap, primary closure, and healing by secondary intention. Primary outcome measures included rate of surgical site infection, recurrence, and length of hospital stay. Secondary outcome measures were hematoma or seroma, and return to work. The search identified 22 articles suitable for inclusion in this review totaling 3693 patients. Analysis showed a 50% reduction in the rate of infection and recurrence in patients receiving closure with flaps compared with primary midline closure and healing by secondary intention. The Karydakis flap was shown to be more favorable cosmetically; however, it failed to compete with the classic and modified Limberg flap in treatment of complicated disease. No significant difference was noted between the modified Limberg and Limberg flap. These results show that the Karydakis flap, classic, and modified Limberg flap demonstrate significant benefits over healing by secondary intention and primary closure.

Common surgical procedures in pilonidal sinus disease: A meta-analysis, merged data analysis, and comprehensive study on recurrence

We systematically searched available databases. We reviewed 6,143 studies published from 1833 to 2017. Reports in English, French, German, Italian, and Spanish were considered, as were publications in other languages if definitive treatment and recurrence at specific follow-up times were described in an English abstract. We assessed data in the manner of a meta-analysis of RCTs; further we assessed non-RCTs in the manner of a merged data analysis. In the RCT analysis including 11,730 patients, Limberg & Dufourmentel operations were associated with low recurrence of 0.6% (95%CI 0.3–0.9%) 12 months and 1.8% (95%CI 1.1–2.4%) respectively 24 months postoperatively. Analysing 89,583 patients from RCTs and non-RCTs, the Karydakis & Bascom approaches were associated with recurrence of only 0.2% (95%CI 0.1–0.3%) 12 months and 0.6% (95%CI 0.5–0.8%) 24 months postoperatively. Primary midline closure exhibited long-term recurrence up to 67.9% (95%CI 53.3–82.4%) 240 months post-surgery. For most procedures, only a few RCTs without long term follow up data exist, but substitute data from numerous non-RCTs are available. Recurrence in PSD is highly dependent on surgical procedure and by follow-up time; both must be considered when drawing conclusions regarding the efficacy of a procedure.

Prospective randomized study of surgical treatment of pilonidal sinus; primary midline closure after elliptical excision versus rhomboid excision with limberg flap reconstruction versus open excision and healing by secondary intention

Background: Best surgical treatment of pilonidal sinus is always challenging for a surgeon in term of recurrence. Evaluation of surgical treatment of pilonidal sinus; primary midline closure after elliptical excision versus rhomboid excision with limberg flap reconstruction versus open excision and healing by secondary intention of sacrococcygeal pilonidal disease.Methods: In this prospective randomized study of 75 patients of sacrococcygeal pilonidal sinus were divided into 3 equal groups through randomly assigning the type of surgery. 25 patients of each group. Group I was operated by primary midline closure after elliptical excision, Group II rhomboid excision with limberg flap reconstruction and Group III open excision and healing by secondary intention.Results: Data was assessed between three groups in term of operative time, healing time and recurrence over a follow up period of 1 year. Mean operative time in group I (primary midline closure after elliptical excision) was 38.7±5.1 minutes, group II (Rhomboid excision with Limberg flap reconstruction) was 124.2±5.6 minutes, group III (Open excision and healing by secondary intention) was 20.6±5.6 minutes. Mean healing time for group I was 19.0±7.4 days, for group II was 17.0±8.0 days and for group III was 60±9.6 days. Recurrence occurred in 3 patients in group I and nil in group II and III.Conclusions: Rhomboid excision with limberg flap reconstruction is better choice than primary midline closure after elliptical excision and open excision in terms of healing time and reoccurrence in cases of sacrococcygeal pilonidal sinus.

Abdominal Wall Expanding System Obviates the Need for Lateral Release in Giant Incisional Hernia and Laparostoma.

In large incisional hernias and after laparostoma midline closure may be impossible. A novel abdominal wall expander system (AWEX) is proposed and evaluated. In patients with large incisional hernias and laparostoma where primary midline closure was impossible, AWEX was used. Patients undergoing abdominal wall reconstruction using AWEX between May 2012 and December 2015 were included. Intraoperative the abdominal wall was stretched by attaching the midline fascia borders to a retraction system under tension for 30 minutes. Length and width of the hernia defect were measured in preoperative computed tomography. Width gain after AWEX procedure, operative time, morbidity, and presence of remaining midline gap was evaluated. Patients were followed for hernia recurrence. Ten patients with incisional hernias (N = 4) and grafted laparostoma (N = 6) underwent abdominal wall reconstruction using AWEX. Median (interquartile range) length and width of the hernia defect was 18.0 (15.0-20.5) and 12.0 (11.8-13.3) cm. Width gain after AWEX was 8.5 (8.0-10.5) cm. Operative time was 270 (135-379) minutes. The major morbidity was 20%. In 4 patients a gap of 4 (4-5) cm was bridged by intraperitoneal onlay mesh. After a median follow-up of 21 (7-36) months no hernia recurrence was observed. Stretching of the abdominal wall that has been shown successful using progressive restressed retention sutures and progressive preoperative pneumoperitoneum is reduced from days and weeks to 30 minutes in AWEX. AWEX is a promising alternative to component separation in repair of large incisional hernias. After refinement of the system prospective evaluation is required.

Impact of spinal versus general anesthesia on postoperative pain and long term recurrence after surgery for pilonidal disease

Study objectiveTo assess the effect of the kind of anesthesia on postoperative pain and long term recurrence rate in pilonidal sinus disease. DesignRetrospective study. SettingSurgical departments of German Armed Forces Hospitals in Hamburg, Bad Zwischenahn and Hamm. Patients583 pilonidal sinus disease (PSD) surgery patients operated for pilonidal disease. InterventionInterview of randomly selected patients, who had been followed up to 20years after PSD surgery. MeasurementsAnalysis of long term recurrence-free survival and postoperative pain scores among patients who received different anesthesia modalities. Main resultsRecurrence occurred in 21.97% of patients who received general anesthesia with intubation (ITN), in 23.32% of spinal anesthesia (SPA), and in 31.91% of local- or cryoanesthesia. Our data indicate that there was no significant difference in recurrence-free time between the types of anesthesia in any of the surgical procedures applied. Pain scores of patients who underwent primary midline closure (4.74±2.63, 95% CI [4.36, 5.12]) were significantly lower than pain scores of patients who underwent marsupialization (6.12±2.71, 95% CI [5.17, 7.07]) or primary open treatment (6.09±2.79, 95% CI [5.79, 6.39]) (P<.0001). Post-operative pain scores did not differ between patients who received ITN or SPA. Cryo- or local anesthesia resulted in significantly lower post-operative pain scores compared to ITN (P=.0089) or SPA (P=.0031). ConclusionThe use of SPA or general anesthesia did not affect the long term recurrence rate in PSD. Postoperative pain experienced either in-hospital or after discharge did not differ between patients receiving ITN or SPA. With other cryo- or local anesthesia, postoperative pain score was significantly reduced in any surgical procedure. However, due to the higher recurrence rate after cryo- or local anesthesia, only SPA and general anesthesia should be applied. The decision whether spinal or general anesthesia is applied in PSD surgery remains a purely anesthesiological decision based on standard considerations.

Cleft lift versus standard excision with primary midline closure for the treatment of pilonidal disease. A snapshot of worldwide current practice

Several surgeries are available to treat pilonidal disease. We analysed the relative effects of conventional excision with primary midline closure compared with the cleft lift procedure on the clinical outcomes of recent published reports. A total of 14 studies containing 2089 patients were included in the analysis. At pooled analysis of available data, the cleft lift procedure showed significantly lower rate of recurrence, shorter time to complete wound healing and faster return to daily activities. The quality of available inherent evidence is not sufficient to draw definitive conclusions. Although the clinical heterogeneity among studies represents a valid concern, the quantitative synthesis of the recent literature seems to support the use of the cleft lift over conventional excision with primary midline closure.

Improving outcomes in pilonidal sinus disease

BackgroundOptimal surgical treatment for pilonidal sinus disease remains controversial. Studies in children are uncommon with overall high postoperative recurrence and infection rates (20%). Our unit adopted a technique for excision of the pilonidal sinus with primary midline closure using a full-thickness flap. We present our results of this technique in the pediatric age group. MethodsSingle-center retrospective review and telephone follow-up was performed, including all children undergoing pilonidal sinus excision from 2005 to 2014 using the same operative technique and preoperative/postoperative care. Results19 children were identified. Median age was 15years, and 47% were male. All had previously infected sinuses, with 5 requiring abscess drainage. Median follow-up was 13months (3.5–67months). Histology confirmed pilonidal sinus in 18/19 cases (one developmental malformation excluded from subsequent analysis). Recurrence requiring further surgery occurred in 4/18 (22%) patients at a median of 9months (range 8–36), wound dehiscence in 8/18 (44%), and wound infection in 5/18 (28%) cases. Laser hair removal of the natal cleft was performed in 7/18 (39%) patients with no further recurrence. ConclusionThis is the first report of this technique in children which showed a higher incidence of complications than a comparable adult study. Our study underlines the importance of accurate long-term outcomes when introducing new techniques to evaluate operation-associated morbidity. Our preliminary results of laser hair removal are promising but need to be evaluated with a prospective study.

Does Full Wound Rupture following Median Pilonidal Closure Alter Long-Term Recurrence Rate?

Objective: The purpose of this study was to examine the recurrence rate of wound rupture in primary pilonidal sinus disease (PSD) after median closure. Subjects and Methods: A total of 583 patients from the German military cohort were interviewed. We compared the choice of surgical therapy, wound dehiscence (if present) and long-term recurrence-free survival for patients with primary open treatment, marsupialization and primary median treatment (closed vs. secondary open, respectively). Actuarial recurrence rate was determined using the Kaplan-Meier calculation with a follow-up of up to 20 years after primary PSD surgery. Results: Patients with excision followed by primary open wound treatment showed a significantly lower 5- than 10-year recurrence rate (8.3 vs. 11.2%) compared to the patients with primary midline closure (17.4 vs. 20.5%, p = 0.03). The 20-year recurrence rate was 28% in primary open wound treatment versus 44% in primary midline closure without wound rupture. In contrast to these findings, long-term recurrence rates following secondary open wound treatment (12.2% at 5 years vs. 17.1% at 10 years) tended to be higher (although not significantly, p = 0.57) compared to primary open treatment (8.3% at 5 years vs. 11.2% at 10 years). There was no statistical difference in long-term recurrence rates between secondary open and primary midline closure (p = 0.7). Hence, despite only a short wound closure time experienced before wound rupture, the patient does not fully benefit from an open wound treatment in terms of recurrence rate. Conclusion: The postoperative pilonidal sinus wound rupture of primary midline closures did not significantly increase the 5- and 10-year long-term recurrence rates compared to uneventfully healing primary midline closures.