The management of pilonidal disease

A systematic review

Julia Grabowski, Tolulope A. Oyetunji, Adam B. Goldin, Robert Baird, Ankush Gosain, Dave R. Lal, Akemi Kawaguchi, Cynthia Downard, Juan E Sola, L. Grier Arthur, Julia Shelton, Karen A. Diefenbach, Lorraine I. Kelley-Quon, Regan F. Williams, Robert L. Ricca, Roshni Dasgupta, Shawn D. St. Peter, Stig Sømme, Yigit S. Guner, Tim Jancelewicz

Research output: Contribution to journalReview article

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).

Original languageEnglish (US)
JournalJournal of Pediatric Surgery
DOIs
StatePublished - Jan 1 2019

Fingerprint

Disease Management
Pediatrics
Minimally Invasive Surgical Procedures
Patient Preference
Evidence-Based Practice
Practice Guidelines
PubMed
Meta-Analysis
Consensus
Databases
Guidelines
Recurrence
Therapeutics

Keywords

  • Adolescent
  • Pediatric
  • Pilonidal
  • Sinusectomy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health

Cite this

Grabowski, J., Oyetunji, T. A., Goldin, A. B., Baird, R., Gosain, A., Lal, D. R., ... Jancelewicz, T. (2019). The management of pilonidal disease: A systematic review. Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2019.02.055

The management of pilonidal disease : A systematic review. / Grabowski, Julia; Oyetunji, Tolulope A.; Goldin, Adam B.; Baird, Robert; Gosain, Ankush; Lal, Dave R.; Kawaguchi, Akemi; Downard, Cynthia; Sola, Juan E; Arthur, L. Grier; Shelton, Julia; Diefenbach, Karen A.; Kelley-Quon, Lorraine I.; Williams, Regan F.; Ricca, Robert L.; Dasgupta, Roshni; St. Peter, Shawn D.; Sømme, Stig; Guner, Yigit S.; Jancelewicz, Tim.

In: Journal of Pediatric Surgery, 01.01.2019.

Research output: Contribution to journalReview article

Grabowski, J, Oyetunji, TA, Goldin, AB, Baird, R, Gosain, A, Lal, DR, Kawaguchi, A, Downard, C, Sola, JE, Arthur, LG, Shelton, J, Diefenbach, KA, Kelley-Quon, LI, Williams, RF, Ricca, RL, Dasgupta, R, St. Peter, SD, Sømme, S, Guner, YS & Jancelewicz, T 2019, 'The management of pilonidal disease: A systematic review', Journal of Pediatric Surgery. https://doi.org/10.1016/j.jpedsurg.2019.02.055
Grabowski, Julia ; Oyetunji, Tolulope A. ; Goldin, Adam B. ; Baird, Robert ; Gosain, Ankush ; Lal, Dave R. ; Kawaguchi, Akemi ; Downard, Cynthia ; Sola, Juan E ; Arthur, L. Grier ; Shelton, Julia ; Diefenbach, Karen A. ; Kelley-Quon, Lorraine I. ; Williams, Regan F. ; Ricca, Robert L. ; Dasgupta, Roshni ; St. Peter, Shawn D. ; Sømme, Stig ; Guner, Yigit S. ; Jancelewicz, Tim. / The management of pilonidal disease : A systematic review. In: Journal of Pediatric Surgery. 2019.
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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).",
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AU - Gosain, Ankush

AU - Lal, Dave R.

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AU - Sola, Juan E

AU - Arthur, L. Grier

AU - Shelton, Julia

AU - Diefenbach, Karen A.

AU - Kelley-Quon, Lorraine I.

AU - Williams, Regan F.

AU - Ricca, Robert L.

AU - Dasgupta, Roshni

AU - St. Peter, Shawn D.

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AU - Guner, Yigit S.

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