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A Journal on Surgery

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Minerva Chirurgica 2013 April;68(2):199-205

language: English

Is there a difference in outcome (long-term recurrence rate) between emergency and elective pilonidal sinus surgery?

Doll D. 1, 2, Evers T. 3, Krapohl B. 4, Matevossian E. 2

1 Department of Visceral Thoracic and Vascular Surgery Philipps‑University of Marburg Marburg, Germany;
2 Department of Surgery Klinikum rechts der Isar, Munich, Germany;
3 Department of Surgery Military Hospital Berlin, Berlin, Germany;
4 Department of Plastic and Reconstructive Surgery and Burns Military Hospital Berlin, Berlin, Germany


Aim: The influence of surgical craftsmanship and decision making on long-term recurrence rate has not been investigated yet.
Methods: A total of 586 patients with surgery for primary pilonidal sinus disease were subjected to a telephone interview 7-25 years after surgery to determine 10- and 20 year recurrence rate using Kaplan Meier Statistics.
Results: Results show that 546 patients had elective surgery showing a recurrence rate of 23.1% (actuarial 10.6-17% after 5-10 years). Forty patients had urgent off-time surgery with crude long-term recurrence rate 30%; actuarial 25.6-28.9% after 5-10 years); P=0.028; logrank. Mind bogglingly, Methylene blue application was dramatically reduced in the urgent group compared to the elective group, although Methylene blue is known to halve recurrence rate.
Conclusion: Surgical craftsmanship quality was identical in elective and urgent pilonidal sinus surgery with comparable long-term recurrence rate. Decision making was markedly biased in urgent off-time pilonidal sinus surgery, counteracting the good long-term recurrence rate enabled by proper surgical craftsmanship.

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