43 - Freie Mitteilung
16. Mai 2019, 08:30 - 10:00, Szenario 1, 5. OG
Impact of geography of disease burden, surgical approaches and recurrence in global pilonidal sinus disease. A Swiss perspective
A. Orlik1, D. Doll2, P. Kauf3, M. Schmid3, M. Lüdi1, V. Stauffer1, Presenter: A. Orlik1 (1Bern, 2Hannover/DE, 3Zürich)
The incidence of pilonidal sinus disease (PSD) is rising both in Switzerland and globally. Very recently we showed in a meta- and merged-data analysis of > 700 studies that recurrence rates in PSD depend on specific surgical procedures and follow-up time.1 Geography and respective settings have been shown to affect a manifold of diseases. However, the global distribution of surgical approaches and the respective recurrence rates have never been studied in PSD. We therefore aimed at studying the impact of geographic distribution of surgical approaches to treat PSD and respective recurrence rates.
Reviewing 6,143 publications from the years 1833 to 2017 in English, French, German, Italian, and Spanish language, we identified 740 including data on geography of origin, recurrence rate, and follow-up time and >80’000 patients. We then assessed data in the manner of a merged data analysis for 12, 24, 60 and 120 months with linear interpolation to discover the impact of geographic distribution of surgical approaches and respective recurrence rates.
Our data provide comprehensive insights for all approaches in all geographic regions. The Limberg and Dufourmentel approach (incl. modifications such as rhomboid flap, teardrop flap and z-plasty) for example showed globally the lowest recurrence rate (0.3% after 1 year, 95% CI 0.2-0.4%). While, for example a primary open strategy shows 0.0% recurrence after 12months in Italy, rates are significantly higher in the U.S. (4.3%, 95% CI 3.6-5.1). Similarly, PSD recurs in the “Pit Picking” approach in 21.0% (95% 16.7-25.3) after 12 months in Germany but in only 0.4% (95% CI 0.0-1.0) in Turkey.
Our extensive data analyzed show that recurrence rates in PSD not only depend on therapeutic approaches and follow-up time but also on the country and respective settings. This shows that geography impacts surgical approaches and recurrence in PSD patients. Additionally, our data reveals global training opportunities considering specific surgical approaches.