Pit excision with fibrin glue closure versus lateralizing flap procedures in the management of pilonidal sinus disease in adolescents: a 14-year cohort study
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In brief
In brief
This 14-year cohort study compared pit excision with fibrin glue closure to traditional lateralizing flap procedures in 78 adolescents with pilonidal sinus disease. The minimally invasive fibrin glue approach showed significantly lower complication rates, reduced operative time, and fewer reoperations while maintaining similar recurrence rates to traditional techniques.
- Pit excision with fibrin glue (PEF) showed lower recurrence (3%) vs lateralizing flaps (11%) in adolescent pilonidal disease over 14 years.
- PEF significantly reduced repeat interventions (12% vs 49%) and wound dehiscence (3% vs 31%) compared to traditional flap procedures.
- Operative time was significantly shorter with PEF, making it a faster minimally invasive option for chronic pilonidal sinus disease.
- PEF avoids extensive tissue excision while maintaining efficacy, offering a tissue-sparing alternative in pediatric pilonidal management.
- This largest pediatric PEF cohort (78 patients, median 2+ year follow-up) supports its use as first-line surgical treatment in adolescents.
Written by the GCMD Library team from the article.
Abstract
Introduction
Pilonidal sinus disease (PSD) arises in the hair follicles of the gluteal cleft with many cases occurring during adolescence. Early studies of pit excision with fibrin glue closure (PEF), a minimally invasive procedure for the management of chronic PSD, suggest it is safe and effective with similar results to traditional lateralizing flap procedures (LFP), without the need for extensive tissue excision and associated complications. However, these studies lack large sample sizes and prolonged follow-up.
Methodology
All children undergoing primary operative procedures for chronic PSD from May 2009 to February 2022 received either a PEF or a LFP. Recurrence and complications rates alongside their demographic and disease severity data were compared using statistical and Kaplan–Meier analyses.
Results
Seventy-eight children had 33 primary PEF and 45 primary LFP procedures with a median follow-up of 2.21 and 2.52 years, respectively. Demographic and disease severity indicators were similar between groups (p > 0.05). The overall recurrence rate in each cohort was 3% for PEF and 11% for LFP, respectively (p = 0.2346). The all-cause repeat intervention rate was 12% and 49% in the PEF and LFP cohorts, respectively (p = 0.0007). Kaplan–Meier analysis showed a reduction in the requirement of re-operation in the PEF cohort (p = 0.0340). Operative time was significantly decreased in the PEF cohort compared to the LFP cohort (p < 0.0001). Wound dehiscence was significantly decreased in the PEF cohort compared to the LFP cohort (3% vs 31%; p = 0.0026).
Conclusion
This 14-year study is the largest pediatric-focused cohort utilizing PEF to manage PSD and demonstrated clinically relevant decreases in symptom recurrence alongside significantly decreased rates of complications and further surgical intervention compared to traditional LFP techniques. We conclude that PEF is a viable minimally invasive technique in the management of pediatric PSD.