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Evidence summaries

Healing by Primary Versus Secondary Intention after Surgical Treatment for Pilonidal Sinus

There may not be a clear benefit for surgical management of pilonidal sinus by primary closure or open healing by secondary intention. Off-midline closure appears better than midline closure after pilonidal sinus surgery. Level of evidence: "C"

A Cochrane review [Abstract] 1 included 26 studies with a total of 2 530 subjects. 17 studies compared open healing with surgical closure. Healing times were faster after surgical closure compared with open healing. Surgical site infection (SSI) rates did not differ between treatments; recurrence rates were lower in open healing than with primary closure (RR 0.60, 95% CI 0.42 to 0.87). Six studies compared surgical midline with off-midline closure. Healing times were faster after off-midline closure (MD 5.4 days, 95% CI 2.3 to 8.5). SSI rates were higher after midline closure (RR 3.72, 95% CI 1.86 to 7.42) and recurrence rates were higher after midline closure (Peto OR 4.54, 95% CI 2.30 to 8.96).

Comment: The quality of evidence is downgraded by study quality (inadequate or unclear allocation concealment and more than 20% loss to follow up) and by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Al-Khamis A, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev 2010;(1):CD006213. [PubMed]

Primary/Secondary Keywords