Recurrent Pilonidal Disease Surgery; Is It Second Primary or Reoperative Surgery?

Abstract

Objective: Pilonidal sinus disease (PSD) effects mainly young men’s social and work life with frequent recurrence rate. Reoperation for unimproved or recurrent disease is somehow troublesome. Surgeons may think that changing treatment strategy after recurrence may prevent further relapses of PSD. We analyzed patients with recurrent pilonidal sinus to determine their predisposing features for recurrence and the outcomes of the preferred surgical methods.
Material and Methods: From 2007 to 2012, out of 95 recurrent pilonidal sinus disease (rPSD) patients, 62 operated cases were included and examined retrospectively. Their retrospective data were examined for demographics, 1st and 2nd operation types, patient satisfaction and pain scores. For cases with insufficient preoperative or postoperative data, phone call and interviews were done to obtain data. Some were kindly invited to the outpatient examination. Student’s t test, Mann-Whitney U test, and Kaplan Meier test for disease free survival time were used where appropriate. P values less than 0.05 were accepted to be statistically significant.
Results: Total of 62 rPSD patients were examined. Male:female ratio was 2.9:1. The mean age after 1st and 2nd operations were 24.7 and 28.1 years, respectively. One and five-year recurrence rates were 33.9% and 66.1%, respectively. The mean interval between the 1st and 2nd operations was 45.6 months. Excision and midline closure was the most frequent type of operation followed by flap reconstructions and excision-lay open procedures. The 1st operation types of rPSD cases were different from that of 2nd operations. Pain perception and satisfaction scores were better in flap reconstruction groups.
Conclusion: Reoperative surgery of rPSD is satisfactory with certain precautions. Relapses after flap reconstruction procedures with a well-being period should be referred as second primary disease. Changing surgical strategy is not always indicated as some patients with recurrence have relapsing or second primary disease that have distinct clinical course. Re-flap surgery after any kind of relapse is well appreciated.

Authors declared that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects”, (amended in October 2013).

Written informed consent was not obtained since patients were interviewed with phone call without face to face conversation.

Externally peer-reviewed.

Concept – A.D.U., M.Y.; Design – A.D.U., M.Y.; Supervision – M.Y., N.E.; Resources – A.D.U., Materials – E.B.C., E.S., S.Y.; Data Collection and/or Processing – A.D.U.; Analysis and/or Interpretation – A.D.U., E.O. M.Y., N.E.; Literature Search – A.D.U.; Writing Manuscript – A.D.U.; Critical Review – M.Y., N.E.

No conflict of interest was declared by the authors.

The authors declared that this study has received no financial support.