Author/Authors :
Doll, Dietrich Saarland University - Department of General, Visceral, Vascular and Pediatric Surgery, Switzerland , Doll, Dietrich Technische Universität München - Department of Surgery, Klinikum rechts der Isar, germany , Doll, Dietrich Academic Teaching Hospital of MHH Hannover - St Mary s Hospital Vechta - Department of Surgery, Germany , Doll, Dietrich Academic Teaching Hospital of the Charité - Military Hospital Berlin - Department of Surgery, Germany , Matevossian, Edouard Technische Universität München - Department of Surgery, Klinikum rechts der Isar, germany , Luedi, Markus M. Bern University Hospital (Inselspital) - Department of Anesthesiology and Pain Medicine, Switzerland , Schneider, Ralf HELIOS St. Josefs-Hospital Bochum-Linden - Department of General and VisceralSurgery, Germany , Zypen, Dominic van Swiss Confederation, Federal Social Insurance Office, Switzerland , Novotny, Alexander Technische Universität München - Department of Surgery,Klinikum rechts der Isar, Germany
Abstract :
Objective: The purpose of this study was to examine the recurrence rate of wound rupture in primary pilonidal sinus disease (PSD) after median closure. Subjects and Methods: A total of 583 patients from the German military cohort were interviewed. We compared the choice of surgical therapy, wound dehiscence (if present) and long-term recurrencefree survival for patients with primary open treatment, marsupialization and primary median treatment (closed vs. secondary open, respectively). Actuarial recurrence rate was determined using the Kaplan-Meier calculation with a follow- up of up to 20 years after primary PSD surgery. Results: Patients with excision followed by primary open wound treatment showed a significantly lower 5- than 10-year recurrence rate (8.3 vs. 11.2%) compared to the patients with primary midline closure (17.4 vs. 20.5%, p = 0.03). The 20- year recurrence rate was 28% in primary open wound treatment versus 44% in primary midline closure without wound rupture. In contrast to these findings, long-term recurrence rates following secondary open wound treatment (12.2% at 5 years vs. 17.1% at 10 years) tended to be higher (although not significantly, p = 0.57) compared to primary open treatment (8.3% at 5 years vs. 11.2% at 10 years). There was no statistical difference in long-term recurrence rates between secondary open and primary midline closure (p = 0.7). Hence, despite only a short wound closure time experienced before wound rupture, the patient does not fully benefit from an open wound treatment in terms of recurrence rate. Conclusion: The postoperative pilonidal sinus wound rupture of primary midline closures did not significantly increase the 5- and 10-year long-term recurrence rates compared to uneventfully healing primary midline closures.
