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Evidence summaries

Fibrin Glue for Pilonidal Sinus Disease

There is insufficient evidence regarding any benefits associated with fibrin glue either as monotherapy or as an adjunct to surgery for people with pilonidal sinus disease. Level of evidence: "D"

The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment, lack of blinding, incomplete outcome data) and imprecise results.

Summary

A Cochrane review [Abstract] 1 included 4 studies with a total of 253 subjects. One unpublished study evaluated fibrin glue monotherapy compared with Bascom's procedure, two studies evaluated fibrin glue as an adjunct to Limberg flap and one study evaluated fibrin glue as an adjunct to Karydakis flap.

For fibrin glue monotherapy compared with Bascom's procedure, there were no data available for the primary outcomes of time to healing and adverse events. There was low-quality evidence of less pain on day one after the procedure with fibrin glue monotherapy compared with Bascom's procedure (MD -2.50, 95% CI -4.03 to -0.97). Fibrin glue may reduce the time taken to return to normal activities compared with Bascom's procedure (mean time 42 days with surgery and 7 days with glue, MD -34.80 days, 95% CI -66.82 days to -2.78 days).

Fibrin glue as an adjunct to the Limberg flap may reduce the healing time from 22 to 8 days compared with the Limberg flap alone (MD -13.95 days, 95% CI -16.76 days to -11.14 days). It is uncertain whether use of fibrin glue affects the incidence of postoperative seroma (an adverse event) (RR 0.27, 95% CI 0.05 to 1.61). There was low-quality evidence that fibrin glue, as an adjunct to Limberg flap, may reduce postoperative pain (median 2 versus 4; P < 0.001) and time to return to normal activities (median 8 days versus 17 days; P < 0.001). The addition of fibrin glue to the Limberg flap may reduce the length of hospital stay (MD -1.69 days, 95% CI -2.08 days to -1.29 days).

A single RCT evaluating fibrin glue as an adjunct to the Karydakis flap did not report data for the primary outcome of time to healing. It is uncertain whether fibrin glue with the Karydakis flap affects the incidence of postoperative seroma (adverse event) (RR 3.00, 95% CI 0.67 to 13.46). Fibrin glue as an adjunct to Karydakis flap may reduce length of stay but this is highly uncertain (mean 2 days versus 3.7 days; P < 0.001).

Clinical comments

Note

Date of latest search: 2016-13-12

    References

    • Lund J, Tou S, Doleman B et al. Fibrin glue for pilonidal sinus disease. Cochrane Database Syst Rev 2017;(1):CD011923. [PubMed]

Primary/Secondary Keywords