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19-08-2023 | Original Article

Five-year recurrence after endoscopic approach to pilonidal sinus disease: A multicentre experience

Authors: M. Manigrasso, A. D’Amore, E. Benatti, L. M. Bracchitta, S. Bracchitta, F. Cantarella, A. Carpino, F. Ferrari, G. Gallo, M. La Torre, C. Magnani, E. Magni, A. Margiotta, M. Masetti, L. Mori, F. Pata, M. Pezza, S. Tierno, F. Tomassini, P. Vanini, G. D. De Palma, M. Milone

Published in: Techniques in Coloproctology | Issue 10/2023

Abstract

Purpose

The aim of this study was to evaluate the 5-year recurrence rate of pilonidal sinus disease (PSD) after endoscopic sinusectomy and identify risk factors for recurrence.

Methods

All consecutive patients from September 2011 through December 2017 who underwent endoscopic sinusectomy at seven referral centres for pilonidal sinus treatment were retrospectively analysed from a prospectively maintained database.

Results

Out of 290 patients (185 males versus 105 female, with a mean age of 25.5±6.9), 73 presented recurrence at 5-year follow-up with a recurrence rate of 25.2%. The number of pilonidal sinus with pits off the midline (p = 0.001) and the mean (SD) distance from the most lateral orifice to the midline (p = 0.001) were higher in the group of patients with recurrence at 5-year follow-up. Multivariate analysis demonstrated that the position of the pits off the midline (p = 0.001) and the distance of the most lateral orifice from the midline (p = 0.001) were independent risk factors for recurrence at 5-year follow-up. Receiver operating characteristic (ROC) curve analysis showed that the distance of lateral orifice from midline predicted an 82.2% possibility of recurrence at 5-year follow-up and Youden’s test identified the best cut-off as 2 cm for this variable. Out of 195 cases with the most lateral orifice less than 2 cm from the midline, 13 presented recurrence at 5-year follow-up with a recurrence rate of 6.7%. Out of 95 cases with the most lateral orifice more than 2 cm from midline, 60 showed recurrence at 5-year follow-up with a recurrence rate of 63.2%.

Conclusions

This data may help guide which disease characteristics predict the optimal use of an endoscopic pilonidal sinus technique.

Loganathan A, Zadeh RA, Hartley J (2012) Pilonidal disease: time to reevaluate a common pain in the rear! Dis Colon Rectum 55:491–493PubMedCrossRef

Milone M, Fernandez LM, Musella M, Milone F (2016) Safety and efficacy of minimally invasive video-assisted ablation of pilonidal sinus: a randomized clinical trial. JAMA Surg 151(6):547–553PubMedCrossRef

McCallum IJ, King PM, Bruce J (2008) Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 336(7649):868–871PubMedPubMedCentralCrossRef

Luedi MM, Schober P, Stauffer VK, Diekmann M, Andereggen L, Doll D (2021) Gender-specific prevalence of pilonidal sinus disease over time: a systematic review and meta-analysis. ANZ J Surg 91(7–8):1582–1587PubMedCrossRef

Mayo OH (1833) Observations on injuries and diseases of the rectum. Burgess & Hill, London, pp 45–46

Isik A, Ramanathan R (2020) Approaches to the treatment of pilonidal sinus disease, clinical practice in 2019. Int Wound J 17:508–509. https://doi.org/10.1111/iwj.13265CrossRefPubMed

Iesalnieks I, Ommer A, Herold A, Doll D (2021) German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg 406(8):2569–2580PubMedPubMedCentralCrossRef

Milone M, Musella M, Salvatore G, Leongito M, Milone F (2011) Effectiveness of a drain in surgical treatment of sacrococcygeal pilonidal disease. Results of a randomized and controlled clinical trial on 803 consecutive patients. Int J Colorectal Dis 26:1601–1607PubMedCrossRef

Gallo G, Grossi U, Sturiale A et al (2021) E-consensus on telemedicine in proctology: a RAND/UCLA-modified study. Surgery 170:405–411PubMedCrossRef

10.

Isik A, Idiz O, Firat D (2016) Novel approaches in pilonidal sinus treatment. Prague Med Rep 117:145–152PubMedCrossRef

11.

Milone M, Basso L, Manigrasso M et al (2021) Consensus statement of the Italian Society of Colorectal Surgery (SICCR): management and treatment of pilonidal disease. Tech Coloproctol 25(12):1269–1280PubMedPubMedCentralCrossRef

12.

Meinero P, Mori L, Gasloli G (2014) Endoscopic pilonidal sinus treatment (E.P.Si.T.). Tech Coloproctol 18:389–392PubMedCrossRef

13.

Milone M, Musella M, Di Spiezio SA et al (2014) Video-assisted ablation of pilonidal sinus: a new minimally invasive treatment—a pilot study. Surgery 155:562–566PubMedCrossRef

14.

Milone M, Bianco P, Musella M, Milone F (2014) A technical modification of video-assisted ablation for recurrent pilonidal sinus. Colorectal Dis 16(11):O404–O406PubMedCrossRef

15.

Meinero P, Stazi A, Carbone A, Fasolini F, Regusci L, La Torre M (2016) Endoscopic pilonidal sinus treatment: a prospective multicentre trial. Colorectal Dis 18:O164–O170PubMedCrossRef

16.

Gecim IE, Goktug UU, Celasin H, Balcl D (2016) Video-assisted treatment of pilonidal disease, using a combination of diathermy ablation and phenol application. BMJ Case Rep 2016:bcr2016214629PubMedPubMedCentralCrossRef

17.

Giarratano G, Toscana C, Shalaby M, Buonomo O, Petrella G, Sileri P (2017) Endoscopic pilonidal sinus treatment: long-term results of a prospective series. JSLS 21:e2017.00043PubMedPubMedCentralCrossRef

18.

Milone M, Velotti N, Manigrasso M et al (2020) Long-term results of a randomized clinical trial comparing endoscopic versus conventional treatment of pilonidal sinus. Int J Surg 74:81–85PubMedCrossRef

19.

Emile SH, Elfeki H, Shalaby M et al (2018) Endoscopic pilonidal sinus treatment: a systematic review and meta-analysis. Surg Endosc 32:3754–3762PubMedCrossRef

20.

Tien T, Athem R, Arulampalam T (2018) Outcomes of endoscopic pilonidal sinus treatment (EPSiT): a systematic review. Tech Coloproctol 22:325–331PubMedCrossRef

21.

Basso L, Pietroletti R, Micarelli A et al (2022) The impact of experience on recurrence rates after biopsy punch excision for pilonidal disease. Colorectal Dis 24(8):984–991PubMedPubMedCentralCrossRef

22.

Lord PH, Millar DM (1965) pilonidal sinus: a simple treatment. Br J Surg 52:298–300PubMedCrossRef

23.

Mendes CRS, Ferreira LSM, Salim L (2019) Brazilian and Argentinean multicentric study in the surgical minimally invasive treatment of pilonidal cyst. Arq Bras Cir Dig 32:e1447PubMedPubMedCentralCrossRef

24.

Kalaiselvan R, Liyanage A, Rajaganeshan R (2020) Short-term outcomes of endoscopic pilonidal sinus treatment. Ann R Coll Surg Engl 102:94–97PubMedCrossRef

25.

Khafagy A, Al Haddad E, AlSabah S (2019) The endoscopic treatment of pilonidal sinus disease: a short-term case-series study. Ann Saudi Med 39:192–196PubMedPubMedCentralCrossRef

26.

Eastment J, Slater K (2020) Outcomes of minimally invasive endoscopic pilonidal sinus surgery. Asian J Endosc Surg 13:324–328PubMedCrossRef

27.

Manigrasso M, Velotti N, Sosa Fernandez LM et al (2021) Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis. Int J Colorectal Dis 36:339–345PubMedCrossRef

28.

Azhough R, Azari Y, Taher S, Jalali P (2021) Endoscopic pilonidal sinus treatment: a minimally invasive surgical technique. Asian J Endosc Surg 14:458–463PubMedCrossRef

29.

Manigrasso M, Velotti N, Sosa Fernandez LM et al (2021) Endoscopic approach to recurrent pilonidal sinus: a retrospective analysis. J Laparoendosc Adv Surg Tech 31:41–53CrossRef

30.

Gallo G, Carpino A, De Paola G et al (2021) Endoscopic pilonidal sinus treatment: a tertiary care academic center experience. Front Surg 8:723050PubMedPubMedCentralCrossRef

31.

Foti N, Passannanti D, Libia A, Campanile FC (2021) A minimally invasive approach to pilonidal disease with endoscopic pilonidal sinus treatment (EPSiT): a single-center case series with long-term results. Tech Coloproctol 25:1045–1054PubMedCrossRef

32.

Baxter J, Espinosa JA, Leinwand MJ (2022) The EPIC procedure (Endoscopicassisted Pilonidal Irrigation and Cleaning): a simple and effective treatment for pilonidal disease. Surg Endosc 36(2):1380–1384PubMedCrossRef

33.

Chia CLK, Tay VWY, Mantoo SK (2015) Endoscopic pilonidal sinus treatment in the Asian population. Surg Laparosc Endosc Percutaneous Tech 25:e95–e97CrossRef

34.

Milone M, Velotti N, Manigrasso M, Milone F, Sosa Fernandez LM, De Palma GD (2019) Video-assisted ablation of pilonidal sinus (VAAPS) versus sinusectomy for treatment of chronic pilonidal sinus disease: a comparative study. Updates Surg 71:179–183PubMedCrossRef

35.

Romaniszyn M, Swirta JS, Walega PJ (2020) Long-term results of endoscopic pilonidal sinus treatment vs Limberg flap for treatment of difficult cases of complicated pilonidal disease: a prospective, nonrandomized study. Colorectal Dis 22:319–324PubMedCrossRef

36.

Javed MA, Fowler H, Jain Y, Singh S, Scott M, Rajaganeshan R (2016) Comparison of conventional incision and drainage for pilonidal abscess versus novel endoscopic pilonidal abscess treatment (EPAT). Tech Coloproctol 20:871–873PubMedCrossRef

37.

Jain Y, Javed MA, Singh S, Rout S, Joshi H, Rajaganeshan R (2017) Endoscopic pilonidal abscess treatment: a novel approach for the treatment of pilonidal abscess. Ann R Coll Surg Engl 99:134–136PubMedPubMedCentralCrossRef

38.

Pérez-Bertólez S, Martín-Solé O, Moraleda I et al (2021) Advantages of endoscopic pilonidal sinus treatment. Cir Pediatr 34:191–199PubMed

39.

Manigrasso M, Anoldo P, Cantore G et al (2022) Endoscopic treatment of pilonidal sinus disease: state of art and review of the literature. Front Surg 4(8):812128CrossRef

40.

Vertaldi S, Anoldo P, Cantore G et al (2022) Histopathological examination and endoscopic sinusectomy: is it possible? Front Surg 3(9):793858CrossRef

41.

Dettmer M, Bonni M, Doll D (2022) The long-term recurrence rate of minimally invasive methods in pilonidal sinus disease therapy is still unclear. Tech Coloproctol 26(2):157–158PubMedCrossRef

42.

Velotti N, Manigrasso M, Di Lauro K et al (2019) Minimally invasive pilonidal sinus treatment: a narrative review. Open Med (Wars) 14:532–536PubMedCrossRef

43.

Velotti N, Manigrasso M, Di Lauro K et al (2019) Minimally invasive pilonidal sinus treatment: a narrative review. Open Med (Wars) 14:532–536PubMedCrossRef

44.

Doll D (2010) 5- and 10-Year recurrence rate is the new gold standard in pilonidal sinus surgery benchmarking. Med Princ Pract 19:216–217PubMedCrossRef

45.

Milone M, Velotti N, Manigrasso M, Anoldo P, Milone F, De Palma GD (2018) Long-term follow-up for pilonidal sinus surgery: a review of literature with metanalysis. Surgeon 16:315–320PubMedCrossRef

46.

Milone M, Gallo G, Grossi U et al (2022) Endoscopic sinusectomy—‘a rose by any other name’. A systematic review of different endoscopic procedures to treat pilonidal disease. Colorectal Dis 25(2):177–190PubMedCrossRef

47.

von Elm E, Altman DG, Egger M et al (2008) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol 61(4):344–349CrossRef

48.

Milone M, Sosa Fernandez LM, Vertaldi S et al (2020) Video-assisted ablation of pilonidal sinus—a video vignette. Colorectal Dis 22:597–598PubMedCrossRef

49.

Maione F, D’Amore A, Milone M et al (2022) Endoscopic approach to complex or recurrent pilonidal sinus: a retrospective analysis. Int Wound J 20(4):1212–1218PubMedPubMedCentralCrossRef

50.

Milone M, Di Minno MN, Bianco P, Coretti G, Musella M, Milone F (2016) Pilonidal sinus surgery: could we predict postoperative complications? Int Wound J 13(3):349–353PubMedCrossRef

51.

Meinero P, La Torre M, Lisi G et al (2019) Endoscopic pilonidal sinus treatment (EPSiT) in recurrent pilonidal disease: a prospective international multicenter study. Int J Colorectal Dis 34(4):741–746PubMedCrossRef

Title: Five-year recurrence after endoscopic approach to pilonidal sinus disease: A multicentre experience
Authors: M. Manigrasso
A. D’Amore
E. Benatti
L. M. Bracchitta
S. Bracchitta
F. Cantarella
A. Carpino
F. Ferrari
G. Gallo
M. La Torre
C. Magnani
E. Magni
A. Margiotta
M. Masetti
L. Mori
F. Pata
M. Pezza
S. Tierno
F. Tomassini
P. Vanini
G. D. De Palma
M. Milone
Publication date: 19-08-2023
Publisher: Springer International Publishing
Published in: Techniques in Coloproctology / Issue 10/2023
Print ISSN: 1123-6337
Electronic ISSN: 1128-045X
DOI: https://doi.org/10.1007/s10151-023-02846-7

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Five-year recurrence after endoscopic approach to pilonidal sinus disease: A multicentre experience

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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