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Incision and drainage preceding definite surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients

Authors

  • Dietrich Doll,

    1. Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Marburg, Germany
    2. Department of Surgery, St.-Marien-Hospital Vechta, Teaching Hospital of the MHH Hannover University, Vechta, Germany
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  • Edouard Matevossian,

    1. Klinikum rechts der Isar, Department of Surgery, Technische Universität München, Munich, Germany
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  • Christian Hoenemann,

    1. Department of Anaesthesiology and Intensive Care, St.-Marien-Hospital Vechta, Teaching Hospital of the MHH Hannover University, Vechta, Germany
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  • Sebastian Hoffmann

    1. Department of Visceral, Thoracic and Vascular Surgery, Philipps-University of Marburg, Marburg, Germany
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  • Conflict of interest None.

Dietrich Doll, MD, PhD, Department of Surgery, St.-Marien-Hospital Vechta, Marienstrasse 6, 49377 Vechta, Germany. E-mail: ddoll@gmx.de

Summary

Background: It has long been suspected that acute infection leads to less satisfactory results in soft tissue surgery. Its influence on long-term recurrence rate in primary pilonidal sinus surgery has not been investigated yet.

Patients and Methods: 583 patients (military cohort) were analyzed, comparing an incision and drainage (I&D) group preceding surgery (n = 286 pts) with a spontaneous abscess and empyema rupture group (n = 297 pts). Long-term recurrence rate up to 25 years following surgery was determined.

Results: The I&D group achieved a 20 year recurrence rate of 24 %, whereas the non-I&D-group had 35 % recurrences (p = 0.0034). Analyzing the subgroup with primary open wound treatment (n = 349 pts), the I&D group did significantly better after 20 years (16 % actuarial recurrence rate versus 34 %; p = 0.009; log-rank-test).

Conclusions: Early I&D treatment preceding definite surgery for some weeks seem to give significant superior results compared to primary surgery without I&D. The combination of early I&D and asymmetric excision and out of the midline closure is expected to give even further improved results compared to this cohort. The optimum interval between I&D and definite surgery has still to be determined.

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