Timeline of recurrence after primary and secondary pilonidal sinus surgery.
ABSTRACT This study was designed to evaluate the timeline of recurrence of pilonidal sinus disease after primary vs. multiple surgery. Data of medical military service in Germany were reviewed.
Telephone interview of 205 patients after pilonidal sinus disease surgery after median interval of 14.8 (standard deviation +/-3.9) years was conducted. A total of 345 patient charts with pilonidal sinus disease recurrence and fully documented previous surgery history were analyzed.
Pilonidal sinus disease recurred in 41 of 205 patients (20 percent; actuarial survival 22 percent) after first surgery. Median recurrence-free-interval was 1.8 (range, 0.1-16.5) years. Twenty-nine of 41 of all recurrences (71 percent) were observed within four years after primary surgery. Fifteen of 50 patients (30 percent) treated by primary closure had recurrent disease after a median recurrence-free interval of 2.7 (range, 0.2-13.5) years compared with 24 of 144 patients (17 percent), who experienced recurrence after rhomboid excision and open wound treatment after a median of 1.8 (range 0.1-16.5) years (P = 0.081, long-rank-test). Analysis of 345 recurrent disease charts revealed that recurrence time decreased for multiple recurrences compared with first recurrence (R1 vs. R2: P = 0.07; R2 vs. R3: P = 0.03, Mann-Whitney U test).
Long-term recurrence rate was 22 percent and thus higher than previously reported. This may be attributed to the long follow-up interval. Recurrences up to 20 years after surgery were seen. Our data provide evidence that follow-up after first to the third pilonidal sinus surgery should complete or exceed five years, because the majority of recurrences occur during this postoperative interval. Nevertheless, even a five-year follow-up will still miss 25 percent of recurrences.
- coloproctology 12/2011; 33(6). DOI:10.1007/s00053-011-0234-8
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ABSTRACT: A personal series of 141 patients with postanal pilonidal sinus was treated by the Karydakis operation. Each sinus was totally excised with a vertical eccentric elliptical excision. A thick flap was created by undercutting the medial edge and advancing it across the midline so that the whole suture line was lateralized to reduce the risk of recurrence. Follow-up was achieved in 114 patients for 1-108 months; 79 (69 per cent) were followed for more than 18 months. Overall there were five recurrences (4 per cent) which required further surgery. Thirty-three patients (23 per cent) were referred following recurrence or failure of healing after previous surgery elsewhere; all were cured by this method. The Karydakis operation has a low recurrence rate because it produces a shallow midline furrow free from scar or suture holes which is less vulnerable to hair penetration than a midline wound.British Journal of Surgery 10/1996; 83(10):1452-5. DOI:10.1002/bjs.1800831040 · 5.21 Impact Factor
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ABSTRACT: To study the potential benefits of intraoperative methylene blue (MB) use in pilonidal sinus surgery, the correlation between long-term recurrence rate and intraoperative MB use in pilonidal sinus surgery was investigated. Explicit investigations of MB effects in sinus surgery are scarce and inconclusive; an effect on long-term recurrence rate has never been systematically investigated. A random selection of 247 patients out of 1,960 patients with primary sinus surgery was drawn, and the patients were subjected to a telephone interview according to a specific questionnaire. The interview covered a recurrence follow-up time of 14.9 years after surgery (mean, standard deviation=3.8 years, range 8.6-25.4 years). Recurrence was less likely to occur when MB was used intraoperatively (32 of 197, [16% actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences with MB vs 15 of 50, 30% [actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences without MB; p=0.018; log-rank test). This effect was especially pronounced in acute abscess-forming disease (8 of 46, 17% [actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences with MB; 11 of 33, 33% [actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences without MB; p=0.078; log-rank test) compared to chronic disease (24 of 151, 16% [actuarial 20-year recurrence rate, Kaplan-Meier estimate]) recurrences with MB; 4 of 17, 24% [actuarial 20-year recurrence rate, Kaplan-Meier estimate] recurrences without MB; p=0.35; log-rank test). MB application halves the long-term risk of recurrence for pilonidal sinus patients. This significant reduction in recurrence rate can be achieved by a single careful injection of non toxic inexpensive dye into the sinus at the start of the operation. MB application should therefore be considered as an integral part of pilonidal sinus surgery.International Journal of Colorectal Disease 03/2008; 23(2):181-7. DOI:10.1007/s00384-007-0393-9 · 2.42 Impact Factor