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MUZI'STENSION FREE PRIMARY CLOSURE TECHNIQUE VERSUS THE ENDOSCOPIC PILONIDAL SINUS TREATMENT: A RETROSPECTIVE STUDY.
Gabriella Giarratano2, Pietro Mascagni3, Agnese Cianfarani1, Claudia Mosconi1, Federica Saraceno1, Ilaria Capuano1, Domenico Mascagni3, Pierpaolo Sileri1, Marco Gallinella Muzi*1
1General Surgery, Università di Roma Tor Vergata, Rome, Rome, Italy; 2General surgery, Casa di cura Villa Tiberia, Rome, italy, Italy; 3Surgical Science, Sapienza University, Rome, Italy
Background
Pilonidal sinus disease (PSD) is a common debilitating condition affecting young adults. Despite numerous attempts, the gold standard surgical treatment has yet to be found. Recently, promising results have been reported on Muzi's tension free primary closure technique and the endoscopic pilondal sinus treatment (EPSiT). In this retrospective study we want to compare the performances of the two approaches.
Methods
From April 2011 to November 2016, all patients presenting with PSD at the authors practice were treated with either Muzi's technique or EPSiT. Patients presenting with acute abscess received antibiotic therapy for 2 weeks before surgical treatment. A retrospective analysis of the prospectively enrolled patients was performed and the two techniques have been compared in terms of patients presentation, operative time, hospital stay, post-operative (PO) pain, complications rate, time to return to normal activities and recurrences.
Results
Two operators surgically treated a total of 129 patients (112 males and 17 females). 64 patients were treated with Muzi's technique and 65 with EPSiT; PSDs presenting with multiple fistulas were respectively 26 (41%) and 5 (7.7%). All patients were treated under local anaesthesia and were discharged on the same day. Mean operative time was 30 minutes (range 15-45) for Muzi's technique and 18 minutes (range 12-30) for EPSiT. Median visual analog scale (VAS) pain was 1 (range 0-3) for Muzi's technique and 2.46 (range 1-4) for EPSiT. None of the patients treated with EPSiT suffered complications, while patients who underwent Muzi's technique experienced 2 dehiscence (Clavien-Dindo II) and 2 wound infections (Clavien-Dindo III); in any case, the difference is not statistically significant (p = 0.058). Median time to return to normal activities following Muzi's technique and EPSiT were respectively 8.10 days (range 2-20) and 4.54 days (range 3-7). At 12 months follow-up, patients suffering of a PSD recurrence were 1 in the group treated with Muzi's technique and 4 in the group treated with EPSiT (p = 0.365).
Conclusions
In our experience, both Muzi's tension free primary closure technique and the endoscopic pilonidal sinus treatment have shown optimal results with no significant differences in the examined parameters. Given the difference in patient's baseline PSDs presentation, future prospective studies should compare the two techniques on simple (midline, <2 external openings) and complex (off-midline, ≥3 external openings) PSDs.
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