Ida-Marie Myron Wiinblad, Johan Ulrichsen, Birgitte Brandstrup
{"title":"慢性毛窦疾病手术治疗后的结果:对常用手术技术的系统回顾。","authors":"Ida-Marie Myron Wiinblad, Johan Ulrichsen, Birgitte Brandstrup","doi":"10.1097/DCR.0000000000003688","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The choice of operation for chronic pilonidal sinus disease remains controversial.</p><p><strong>Objective: </strong>To compare the outcomes of common operations for chronic pilonidal disease.</p><p><strong>Data sources: </strong>We searched PubMed, Embase, and the Cochrane Library.</p><p><strong>Study selection: </strong>We included randomized trials in English or Danish language, published 2002 to 2024 that compared outcomes of operations to treat chronic pilonidal disease in adults and teenagers.</p><p><strong>Interventions: </strong>We compared the outcomes of secondary healing, primary midline closure, Bascom, Limberg, and Karydakis flap operations.</p><p><strong>Main outcome measures: </strong>The primary outcome was recurrence; secondary outcomes were infection, healing time, and length of stay. We compared recurrence and infection rates in meta-analyses for all techniques. We assessed the risk of bias and the quality of all trials.</p><p><strong>Results: </strong>Fifty trials included a total of 5762 participants. In a meta-analysis, the flap operations had fewer recurrences than primary midline closure (OR 0.31; 95% CI, 0.19-0.51; p < 0.01). The trials comparing flap operations with secondary healing were heterogeneous and did not reach significance (OR 0.38; 95% CI, 0.13-1.13; p = 0.08). Recurrence was similar between Limberg and Karydakis operations. Infection rates were lower for the flap operations compared with primary closure (OR 0.33; 95% CI, 0.23-0.48; p < 0.01) and with secondary healing (OR 0.48; 95% CI, 0.30-0.77; p < 0.01). Two trials tested Bascom procedure against Limberg operation without significant differences. All trials found secondary healing to have significantly longer healing times than any other operation.</p><p><strong>Limitations: </strong>Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence. The trials generally had small numbers, short follow-ups, and no reported primary outcomes or power calculations.</p><p><strong>Conclusions: </strong>Primary closure and secondary healing performed poorly compared with the flap techniques. Most trials tested Limberg operation; only 2 tested Bascom operation. The literature suggests the surgeon's expertise determines the choice of flap technique.</p>","PeriodicalId":11299,"journal":{"name":"Diseases of the Colon & Rectum","volume":" ","pages":"515-529"},"PeriodicalIF":3.2000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Outcome After Surgical Treatment for Chronic Pilonidal Sinus Disease: A Systematic Review of Common Surgical Techniques.\",\"authors\":\"Ida-Marie Myron Wiinblad, Johan Ulrichsen, Birgitte Brandstrup\",\"doi\":\"10.1097/DCR.0000000000003688\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The choice of operation for chronic pilonidal sinus disease remains controversial.</p><p><strong>Objective: </strong>To compare the outcomes of common operations for chronic pilonidal disease.</p><p><strong>Data sources: </strong>We searched PubMed, Embase, and the Cochrane Library.</p><p><strong>Study selection: </strong>We included randomized trials in English or Danish language, published 2002 to 2024 that compared outcomes of operations to treat chronic pilonidal disease in adults and teenagers.</p><p><strong>Interventions: </strong>We compared the outcomes of secondary healing, primary midline closure, Bascom, Limberg, and Karydakis flap operations.</p><p><strong>Main outcome measures: </strong>The primary outcome was recurrence; secondary outcomes were infection, healing time, and length of stay. We compared recurrence and infection rates in meta-analyses for all techniques. We assessed the risk of bias and the quality of all trials.</p><p><strong>Results: </strong>Fifty trials included a total of 5762 participants. In a meta-analysis, the flap operations had fewer recurrences than primary midline closure (OR 0.31; 95% CI, 0.19-0.51; p < 0.01). The trials comparing flap operations with secondary healing were heterogeneous and did not reach significance (OR 0.38; 95% CI, 0.13-1.13; p = 0.08). Recurrence was similar between Limberg and Karydakis operations. Infection rates were lower for the flap operations compared with primary closure (OR 0.33; 95% CI, 0.23-0.48; p < 0.01) and with secondary healing (OR 0.48; 95% CI, 0.30-0.77; p < 0.01). Two trials tested Bascom procedure against Limberg operation without significant differences. All trials found secondary healing to have significantly longer healing times than any other operation.</p><p><strong>Limitations: </strong>Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence. The trials generally had small numbers, short follow-ups, and no reported primary outcomes or power calculations.</p><p><strong>Conclusions: </strong>Primary closure and secondary healing performed poorly compared with the flap techniques. Most trials tested Limberg operation; only 2 tested Bascom operation. The literature suggests the surgeon's expertise determines the choice of flap technique.</p>\",\"PeriodicalId\":11299,\"journal\":{\"name\":\"Diseases of the Colon & Rectum\",\"volume\":\" \",\"pages\":\"515-529\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Diseases of the Colon & Rectum\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/DCR.0000000000003688\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/2/21 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"GASTROENTEROLOGY & HEPATOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Diseases of the Colon & Rectum","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/DCR.0000000000003688","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/2/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
Outcome After Surgical Treatment for Chronic Pilonidal Sinus Disease: A Systematic Review of Common Surgical Techniques.
Background: The choice of operation for chronic pilonidal sinus disease remains controversial.
Objective: To compare the outcomes of common operations for chronic pilonidal disease.
Data sources: We searched PubMed, Embase, and the Cochrane Library.
Study selection: We included randomized trials in English or Danish language, published 2002 to 2024 that compared outcomes of operations to treat chronic pilonidal disease in adults and teenagers.
Interventions: We compared the outcomes of secondary healing, primary midline closure, Bascom, Limberg, and Karydakis flap operations.
Main outcome measures: The primary outcome was recurrence; secondary outcomes were infection, healing time, and length of stay. We compared recurrence and infection rates in meta-analyses for all techniques. We assessed the risk of bias and the quality of all trials.
Results: Fifty trials included a total of 5762 participants. In a meta-analysis, the flap operations had fewer recurrences than primary midline closure (OR 0.31; 95% CI, 0.19-0.51; p < 0.01). The trials comparing flap operations with secondary healing were heterogeneous and did not reach significance (OR 0.38; 95% CI, 0.13-1.13; p = 0.08). Recurrence was similar between Limberg and Karydakis operations. Infection rates were lower for the flap operations compared with primary closure (OR 0.33; 95% CI, 0.23-0.48; p < 0.01) and with secondary healing (OR 0.48; 95% CI, 0.30-0.77; p < 0.01). Two trials tested Bascom procedure against Limberg operation without significant differences. All trials found secondary healing to have significantly longer healing times than any other operation.
Limitations: Most studies had a high or medium risk of bias, resulting in very low to low certainty of evidence. The trials generally had small numbers, short follow-ups, and no reported primary outcomes or power calculations.
Conclusions: Primary closure and secondary healing performed poorly compared with the flap techniques. Most trials tested Limberg operation; only 2 tested Bascom operation. The literature suggests the surgeon's expertise determines the choice of flap technique.
期刊介绍:
Diseases of the Colon & Rectum (DCR) is the official journal of the American Society of Colon and Rectal Surgeons (ASCRS) dedicated to advancing the knowledge of intestinal disorders by providing a forum for communication amongst their members. The journal features timely editorials, original contributions and technical notes.