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Techniques in Coloproctology
Erschienen in: Techniques in Coloproctology 10/2014

01.10.2014 | Review

Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus

verfasst von: J. M. Enriquez-Navascues, J. I. Emparanza, M. Alkorta, C. Placer

Erschienen in: Techniques in Coloproctology | Ausgabe 10/2014

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Abstract

Background

There are different open healing and primary closure approaches for chronic pilonidal sinus (CPD) that differ in principles and extension.

Aims

To compare the results of different closure surgical techniques, we performed a meta-analysis of randomized controlled trials (RCT) comparing: (1) open wide excision versus open limited excision (sinusectomy) or unroofing (sinotomy); (2) midline closure (conventional and tension-free) versus off-midline; (3) advancing versus rotation flaps; and (4) sinusectomy/sinotomy versus primary closure.

Methods

Data extraction and risk of bias assessment were conducted independently by the authors using the Cochrane Collaboration’s tool. Data were pooled using fixed and random-effects models. Primary outcomes were rate of healing, recurrence, wound infection and dehiscence. Twenty-five trials (2,949 patients) were included.

Results

Four trials compared limited versus radical open healing. Although recurrence rate did not differ, all other outcomes favored the limited approach. Ten studies compared midline versus off-midline primary closure; wound infection and dehiscence were significantly higher after midline closure. Six RCT compared Karydakis/Bascom versus Limberg. No difference was found in recurrence or wound complications rate. Six RCT compared sinusectomy/sinotomy versus primary closure. Recurrence rate was significantly lower after sinusectomy/sinotomy; no significant differences were found in other outcomes.

Conclusion

Our meta-analysis suggest that some of the questions of which is the best surgical technique for CPD have now been answered: open radical excision and primary midline closure should be abandoned. Sinusotomy/sinectomy or en bloc resection with off midline primary closure are the preferred approaches.
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Metadaten
Titel
Meta-analysis of randomized controlled trials comparing different techniques with primary closure for chronic pilonidal sinus
verfasst von
J. M. Enriquez-Navascues
J. I. Emparanza
M. Alkorta
C. Placer
Publikationsdatum
01.10.2014
Verlag
Springer Milan
Erschienen in
Techniques in Coloproctology / Ausgabe 10/2014
Print ISSN: 1123-6337
Elektronische ISSN: 1128-045X
DOI
https://doi.org/10.1007/s10151-014-1149-5

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