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

Doll, Dietrich; Orlik, Andriu; Maier, Katharina; Kauf, Peter; Schmid, Marco; Diekmann, Maja; Vogt, Andreas; Stauffer, Verena K; Lüdi, Markus M. (2019). Impact of geography and surgical approach on recurrence in global pilonidal sinus disease. Scientific reports, 9(1), p. 15111. Springer Nature 10.1038/s41598-019-51159-z

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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.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic and Policlinic for Anaesthesiology and Pain Therapy

UniBE Contributor:

Vogt, Andreas and Lüdi, Markus


600 Technology > 610 Medicine & health




Springer Nature




Jeannie Wurz

Date Deposited:

04 Nov 2019 15:20

Last Modified:

13 Mar 2021 19:00

Publisher DOI:


PubMed ID:





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