Impact of geography and surgical approach on recurrence in global pilonidal sinus disease

Dietrich Doll, Andriu Orlik, Katharina Maier, Peter Kauf, Marco Schmid, Maja Diekmann, Andreas P Vogt, Verena K Stauffer, Markus M Luedi, Dietrich Doll, Andriu Orlik, Katharina Maier, Peter Kauf, Marco Schmid, Maja Diekmann, Andreas P Vogt, Verena K Stauffer, Markus M Luedi

Abstract

Pilonidal sinus disease (PSD) is increasing globally. A recent meta-analysis and merged-data analysis showed that recurrence rates in PSD depend essentially on follow-up time and specific surgical procedures. However, the global distribution of surgical approaches and respective recurrence rates have never been studied in PSD. We aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and subsequent geography-specific recurrence rates. We searched relevant databases as described previously. Recurrence rates were then associated with reported follow-up times and geographic origin. We simulated individual patients to enable analogy across data. Globally, recurrence rates range from 0.3% for Limberg/Dufourmentel approaches (95% CI 0.2-0.4) and flaps (95% CI 0.1-0.5) and up to 6.3% for incision (95% CI 3.2-9.3) at 12 months. Recurrence rates range from 0.3% for Karydakis/Bascom approaches (95% CI 0.0-0.8) up to 67.2% for incision (95% CI 7.5-100) in the USA, and 0.0% for primary asymmetric closure in Germany (95% CI 0.0-0.0). Our analysis shows that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on geography. Primary asymmetric closure and various flap techniques remain superior regardless of the geographical region. Some approaches have extraordinarily good outcomes in specific countries.

Conflict of interest statement

Dietrich Doll, Andriu Orlik, Katharina Maier, Peter Kauf, Marco Schmid, Maja Diekmann, Andreas P. Vogt, Verena K. Stauffer and Markus M. Luedi declare no competing financial interests. This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. There are no relevant or minor financial relationships of authors, their relatives, or next of kin with external companies.

Figures

Figure 1
Figure 1
All countries: Kaplan-Meier-estimator depicting recurrence free outcome of the study population as a function of follow-up time. The data used include all available studies from all geographical regions. 95% confidence intervals are shown by shaded lines. The number of patients at risk for 12, 24, 60, and 120 months follow-up time are shown in Table 1.
Figure 2
Figure 2
United States: Kaplan-Meier estimator depicting recurrence-free outcome of the study population as a function of follow-up time. The data used include all available studies from the United States. 95% confidence intervals are shown by shaded lines. The number of patients at risk of recurrence at 12, 24, 60, and 120 months of follow-up is shown in Table 2.
Figure 3
Figure 3
Germany: Kaplan-Meier estimator depicting recurrence-free outcome of the study population as a function of follow-up time. The data used include all available studies from Germany. 95% confidence intervals are shown by shaded lines. The number of patients at risk of recurrence at 12, 24, 60, and 120 months of follow-up is shown in Table 3.
Figure 4
Figure 4
Turkey: Kaplan-Meier estimator depicting recurrence-free outcome of the study population as a function of follow-up time. The data used include all available studies from Turkey. 95% confidence intervals are shown by shaded lines. The number of patients at risk of recurrence at 12, 24, 60, and 120 months of follow-up is shown in Table 4.
Figure 5
Figure 5
Italy: Kaplan-Meier estimator depicting recurrence-free outcome of the study population as a function of follow-up time. The data used include all available studies from Italy. 95% confidence intervals are shown by shaded lines. The number of patients at risk of recurrence at 12, 24, 60, and 120 months of follow-up is shown in Table 5.
Figure 6
Figure 6
Procedure-specific recurrence rates in PSD [%] are shown at the time point 12 months. Extrapolated or interpolated data are marked with an asterisk (*).
Figure 7
Figure 7
Procedure-specific recurrence rates in PSD [%] are shown at the time point 60 months. Extrapolated or interpolated data are marked with an asterisk (*).

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Source: PubMed

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