Comparison Study between Primary Closure Versus Secondary Closure Surgery for Pilonidal Sinus in Saudi Arabia: 25 Years’ Systematic Review and Meta-analysis

Abstract

Background:  Pilonidal sinus disease is a chronic inflammation and infection of the sacrococcygeal region. It is a common disease, affecting roughly 26 per 100 000 populations, usually appears at age between 15&25 years old and predominantly affects young males. It can cause pain, sepsis, and reduced quality of life and has an impact on the individual's ability to attend work or education. Risk factors for the condition include male gender, young age, obesity, hairiness, deep natal cleft, and poor hygiene.  Aim of Study:  To conduct a systematic review and meta-analysis for studies done in Saudi Arabia comparing lay open versus primary closure for pilonidal sinus done in the past 25 years. Materials and Methods: We have performed an electronic search for PubMed, Cochrane library and Google Scholar, resulted in 241 studies. Then second filter was done for full text excluding 224 studies were unrelated not met inclusion criteria and 17 studies were obtained. 6 studies compared lay open and primary closure techniques, 5 studies only lay open ,4 studies primary closure. Furthermore two papers were excluded from analysis as one not mentions the surgery type and one paper measure the knowledge of the community about pilonidal disease. Results:  Complication rate (infection mean) was 4.505 in lay open group and 9.447 with primary closure group. Recurrence rate was higher in lay open versus primary closure techniques. Conclusion: Lay open procedure was associated with shorter operative time and reduced risk of recurrence or complication rate in comparison to primary closure technique, but it takes more time for hospital stay and wound healing.