Julia Grabowski1, Tolulope A Oyetunji2, Adam B Goldin3, Robert Baird4, Ankush Gosain5, Dave R Lal6, Akemi Kawaguchi7, Cynthia Downard8, Juan E Sola9, L Grier Arthur10, Julia Shelton11, Karen A Diefenbach12, Lorraine I Kelley-Quon13, Regan F Williams5, Robert L Ricca14, Roshni Dasgupta15, Shawn D St Peter2, Stig Sømme16, Yigit S Guner17, Tim Jancelewicz5. 1. Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital, Northwestern University, Chicago, IL. Electronic address: jgrabowski312@gmail.com. 2. Department of Surgery, Children's Mercy Hospital, Kansas City, MO. 3. Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA. 4. Division of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, Canada. 5. Division of Pediatric Surgery, Le Bonheur Children's Hospital, University of Tennessee Health Science Center, Memphis, TN. 6. Division of Pediatric Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI. 7. University of Texas McGovern Medical School and Children's Memorial Hermann Hospital, Houston, TX. 8. Division of Pediatric Surgery, Hiram C. Polk, Jr, MD Department of Surgery, University of Louisville, Louisville, KY. 9. Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL. 10. Division of Pediatric Surgery, St. Christopher's Hospital for Children, Philadelphia, PA. 11. Division of Pediatric Surgery, University of Iowa Stead Family Children's Hospital, Iowa City, IA. 12. Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus, OH. 13. Department of Surgery, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA. 14. Division of Pediatric Surgery, Naval Medical Center, Portsmouth, VA. 15. Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, OH. 16. Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado, Aurora, CO. 17. Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA.
Abstract
OBJECTIVE: The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to derive recommendations from the medical literature regarding the management of pilonidal disease. METHODS: The PubMed, Cochrane, Embase, Web of Science, and Scopus databases from 1965 through June 2017 were queried for any papers addressing operative or non-operative management of pilonidal disease. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived for three questions based on the best available evidence, and a clinical practice guideline was constructed. RESULTS: A total of 193 articles were fully analyzed. Some non-operative and minimally invasive techniques have outcomes at least equivalent to operative management. Minimal surgical procedures (Gips procedure, sinusectomy) may be more appropriate as first-line treatment than radical excision due to faster recovery and patient preference, with acceptable recurrence rates. Excision with midline closure should be avoided. For recurrent or persistent disease, any type of flap repair is acceptable and preferred by patients over healing by secondary intention. There is a lack of literature dedicated to the pediatric patient. CONCLUSIONS: There is a definitive trend towards less invasive procedures for the treatment of pilonidal disease, with equivalent or better outcomes compared with classic excision. Midline closure should no longer be the standard surgical approach. TYPE OF STUDY: Systematic review of level 1-4 studies. LEVEL OF EVIDENCE: Level 1-4 (mainly level 3-4).
OBJECTIVE: The goal of this systematic review by the American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee was to derive recommendations from the medical literature regarding the management of pilonidal disease. METHODS: The PubMed, Cochrane, Embase, Web of Science, and Scopus databases from 1965 through June 2017 were queried for any papers addressing operative or non-operative management of pilonidal disease. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were followed. Consensus recommendations were derived for three questions based on the best available evidence, and a clinical practice guideline was constructed. RESULTS: A total of 193 articles were fully analyzed. Some non-operative and minimally invasive techniques have outcomes at least equivalent to operative management. Minimal surgical procedures (Gips procedure, sinusectomy) may be more appropriate as first-line treatment than radical excision due to faster recovery and patient preference, with acceptable recurrence rates. Excision with midline closure should be avoided. For recurrent or persistent disease, any type of flap repair is acceptable and preferred by patients over healing by secondary intention. There is a lack of literature dedicated to the pediatric patient. CONCLUSIONS: There is a definitive trend towards less invasive procedures for the treatment of pilonidal disease, with equivalent or better outcomes compared with classic excision. Midline closure should no longer be the standard surgical approach. TYPE OF STUDY: Systematic review of level 1-4 studies. LEVEL OF EVIDENCE: Level 1-4 (mainly level 3-4).
Authors: Kevin C Janek; Meaghan Kenfield; Lisa M Arkin; Lily Stalter; Giancarlo Tabaro; Charles M Leys; Hau D Le Journal: Surg Open Sci Date: 2022-04-20
Authors: Mackenzie N Abraham; Steven L Raymond; Russell B Hawkins; Atif Iqbal; Shawn D Larson; Moiz M Mustafa; Janice A Taylor; Saleem Islam Journal: Front Surg Date: 2021-02-25