Surgical interventions for the treatment of sacrococcygeal pilonidal sinus disease in children: A systematic review and meta-analysis
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In brief
In brief
This systematic review of 193 studies demonstrates that minimally invasive techniques for pilonidal disease achieve outcomes equivalent to or better than traditional excision, with faster recovery. Midline closure should be avoided, and flap repair is preferred for recurrent disease.
Written by the GCMD Library team from the article.
Background
Pilonidal sinus disease (PNS) is not uncommon in children. Controversy remains over the best treatment and there is limited evidence. This systematic review and meta-analysis aims to establish which techniques have the best outcomes in children.
Methods
MEDLINE, EMBASE and CENTRAL databases were searched. Studies reporting treatment outcomes for PNS in children were included.
Results
Open healing has pooled risk of recurrence of 26% (95%CI 15–38%), risk of wound complication of 21% (9–36%) and wound healing ranged from 38–92 days. Midline primary closure has pooled risk of recurrence of 12% (8–18%), risk of wound complication of 30% (19–46%) and wound healing ranged from 8 to 32 days. Off-midline primary closure has pooled risk of recurrence of 6% (1–15%), risk of wound complication of 14% (6–25%) and wound healing was 27 days. VAC therapy has pooled risk of recurrence of 20% (0–65%) and wound healing ranged from 38 to 92 days. Minimally invasive techniques has pooled risk of recurrence of 7% (1–16%) and wound healing ranged from 21-30 days. Marsupialisation has pooled risk of recurrence of 6% (0–22%), and wound healing ranged from 6 to 41 days.
Conclusion
Evidence for management of PNS in children is poor. Off-midline primary closure, minimally invasive techniques, and marsupialisation have the best outcomes.
Level of Evidence rating
IV.