Padrões de Recorrência na Cirurgia da Doença do Cisto Pilonidal: Navegando por Classificações Erradas e Complicações Precoces
Recurrence Patterns in Pilonidal Sinus Disease Surgery: Navigating Misclassifications and Early Complications
Dietrich Doll; Christina Oetzmann von Sachoczewski; Henrike Heitmann; Theo Hackmann; Julie Lynge Ankersen; Susanne Haas
Resumo
Introdução: Problemas de cicatrização de feridas são comuns após a cirurgia da Doença do Cisto Pilonidal (DCP), e podem ser mal classificados como recidiva durante os primeiros 6-12 meses pós-operatórios. Adotamos a hipótese de que a classificação errada das complicações pós-operatórias da ferida como recidivas se refletiria ao comparar as taxas anuais precoces e tardias.
Métodos: A taxa de recidiva pós-operatória foi analisada em 1.254 estudos envolvendo 2.030 grupos de tratamento (n=140.472 pacientes), estudos de seguimento menor que um ano (n=304 estudos) versus estudos com seguimento mais longo (n=950 estudos). Foi calculada a taxa de recidiva para os grupos e feita a subanálise para estratégias terapêuticas neste estudo observacional.
Resultados: A taxa de recidiva (TR) no primeiro ano foi significativamente mais elevada nos estudos com seguimento menor que um ano em comparação com estudos com seguimento maior que um ano (TR mediana 6,0%/ano vs. 2,0%/ano, Diferença de Risco (DR)=4,0%). A análise das recidivas das terapias individuais após o tratamento primário aberto indicou TR de 8%/ano contra 2,5%/ano (DR=5,5%), para o fechamento primário da linha média, de 20%/ano vs. 3,2%/ano (DR=16,8%) e para o Pit- Picking, de 20,7%/ano vs. 4,0%/ano (DR=16,7%).
Conclusão: A TR em um ano contém uma parte relevante de classificações erradas (recorrências falsas), que podem exceder a taxa verdadeira de recorrência por um fator de 3-5. Se for necessário determinar uma taxa de recorrência confiável, devem-se evitar seguimentos de menos de um ano. Estudos com 200 participantes ou mais apresentam uma menor probabilidade de erro na taxa de recorrência e devem ser almejados. O que acrescenta este artigo à literatura? Este é o primeiro trabalho a quantificar a classificação errada de “recidivas” no primeiro ano após a cirurgia da DCP.
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Referências
1 Doll D, Oetzmann von Sochaczewski C, Seifert J, Sultansei A, Faurschou IK, Maak M, PiloNERDs_International. From the First Year to a Decade Onwards: How Initial Surgical Technique Determines Long-Term Recurrence Rates in Pilonidal Sinus Disease. DCR 2026 (in submission).
2 da Silva JH. Pilonidal cyst: cause and treatment. DCR. 2000;43:1146-56.
3 Iribarren BO, Barra MM, Lanzelotti GD, Rojas GM, Peña AE. Comparison between Limberg and Karydakis flap for wound closure after pilonidal cyst resection. Rev Chil Cir. 2015;67:399-406.
4 Allen-Mersh TG. Pilonidal sinus: finding the right track for treatment. Br J Surg. 1990;77(2):123-32. doi: 10.1002/bjs.1800770203.
5 Petersen S, Koch R, Stelzner S, Wendlandt TP, Ludwig K. Primary closure techniques in chronic pilonidal sinus: a survey of the results of different surgical approaches. DCR. 2002;45(11):1458-67. doi: 10.1007/s10350-004-6451-2.
6 Stauffer VK, Luedi M, Kauf P, Schmid M, Diekmann M, Wieferich K, et al. Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep. 2018;8(1):1-28. doi: 10.1038/s41598-018-20143-4.
7 Al-Khamis A, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane Database Syst Rev. 2010;2010(1):CD006213. doi: 10.1002/14651858.CD006213.pub3.
8 Doll D, Friederichs J, Dettmann H, Boulesteix AL, Duesel W, Petersen S. Time and rate of sinus formation in pilonidal sinus disease. Int J Col Dis. 2008;23(4):359-64. 10.1007/s00384-007-0389-5.
9 Doll D, Krueger CM, Schrank S, Dettmann H, Petersen S, Duesel W. Timeline of recurrence after primary and secondary pilonidal sinus surgery. Dis Colon Rectum. 2007;50(11):1928-34. doi: 10.1007/s10350-007-9031-4.
10 Bosche F, Luedi MM, van der Zypen D, Moersdorf P, Krapohl B, Doll D. The Hair in the Sinus: Sharp-Ended Rootless Head Hair Fragments can be Found in Large Amounts in Pilonidal Sinus Nests. World J Surg. 2018;42(2):567-73. doi: 10.1007/s00268-017-4093-5.
11 Bosche FD (2017) Physikalische und morphologische Haarcharakteristika von Pilonidalsinuspatienten und ihren Vergleichsprobanden. Dissertation zur Erlangung des Grades eines Doktors der Medizin. In: Unversitätsklinik Homburg (Saar), Allgemein-, Viszeral und Kinderchirurgie. Vol. Dissertation, p. 118. Universität des Saarlandes, Homburg / Saar.
12 Doll D, Bosche F, Hauser A, Moersdorf P, Sinicina I, Grunwald J, et al. The presence of occipital hair in the pilonidal sinus cavity-a triple approach to proof. Int J Colorectal Dis. 2018;33(5):567-76. doi: 10.1007/s00384-018-2988-8.
13 Doll D, Bosche FD, Stauffer VK, Sinicina I, Hoffmann S, Van der Zypen D, et al. Strength of occipital hair as an explanation for pilonidal sinus disease caused by intruding hair. Dis Colon Rectum. 2017;60(9):979-86. doi: 10.1097/DCR.0000000000000795.
14 Haas S, Sorensen MJ, Lundby L, Pedersen AG. Injection of freshly collected autologous adipose tissue into non-healing wounds after closed incision pilonidal surgery. Tech Coloproctol. 2020;24(12):1301-6. doi: 10.1007/s10151-020-02276-9.
15 Faurschou IK, Sorensen MJ, Ladefoged Rasmussen S, Gorm Pedersen A, Haas S. Single-blinded, randomized study comparing healing after Bascom's cleft lift operation for pilonidal disease with or without negative wound pressure management. Colorectal Dis. 2024;27(1):e17198. doi: 10.1111/codi.17198.
16 Sondenaa K, Diab R, Nesvik I, Gullaksen FP, Kristiansen RM, Saebo A, et al. Influence of failure of primary wound healing on subsequent recurrence of pilonidal sinus. combined prospective study and randomised controlled trial. Eur J Surg. 2002;168(11):614-8. doi: 10.1080/11024150201680007.
17 Johnson EK, Vogel JD, Cowan ML, Feingold DL, Steele SR, Surgeons CPGCotASoCaR. The American Society of Colon and Rectal Surgeons' Clinical Practice Guidelines for the Management of Pilonidal Disease. Dis Colon Rectum. 2019;62(2):146-57. doi: 10.1097/DCR.0000000000001237.
18 Iesalnieks I, Ommer A, Herold A, Doll D. German National Guideline on the management of pilonidal disease: update 2020. Langenbecks Arch Surg. 2021;406(8):2569-80. doi: 10.1007/s00423-020-02060-1.
19 Milone M, Basso L, Manigrasso M, Pietroletti R, Bondurri A, La Torre M, et al. Consensus statement of the Italian society of colorectal surgery (SICCR): management and treatment of pilonidal disease. Tech Coloproctol. 2021;25(12):1269-80. doi: 10.1007/s10151-021-02487-8.
20 Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gotzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100. doi: 10.1371/journal.pmed.1000100.
21 Yalcinkaya A, Yalcinkaya A, Sahin C, Balci B, Ozeller E, Ozturk E, et al. Investigating recurrence in pilonidal sinus disease: results of a nationwide, multicenter study in Turkey (PISI TURKEY). Int J Colorectal Dis. 2025;40(1):194. doi: 10.1007/s00384-025-04921-x.
22 Childs DR, Murthy AS. Overview of Wound Healing and Management. Surg Clin North Am. 2017; 7(1):189-207. doi: 10.1016/j.suc.2016.08.013.
23 Levenson SM, Geever EF, Crowley LV, Oates JF, 3rd, Berard CW, Rosen H. The Healing of Rat Skin Wounds. Ann Surg. 1965;161:293-308.
24 Geever EF, Stein JM, Levenson SM. Variations in breaking strength in healing wounds of young guinea pigs. J Trauma. 1965;5(5):624-35. doi: 10.1097/00005373-196509000-00006.
25 Brengelmann IE (2020) Die Rolle der präsakralen Schweißneigung in der Entstehung des Pilonidalsinus. In: Unversitätsklinik Homburg (Saar), Allgemein-, Viszeral und Kinderchirurgie. Vol. Dissertation. Saarland University, Homburg /Saar.
26 Doll D, Brengelmann I, Schober P, Ommer A, Bosche F, Papalois AE, et al. Rethinking the causes of pilonidal sinus disease: a matched cohort study. Sci Rep. 2021;11(1):6210. doi: 10.1038/s41598-021-85830-1.
27 Doll D, Matevossian E, Hoenemann C, Hoffmann S. Incision and drainage preceding definite surgery achieves lower 20-year long-term recurrence rate in 583 primary pilonidal sinus surgery patients. J Dtsch Dermatol Ges. 2013;11(1):60-4. doi: 10.1111/j.1610-0387.2012.08007.x.
28 Doll D, Novotny A, Rothe R, Kristiansen JE, Wietelmann K, Boulesteix AL, et al. Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Colorectal Dis. 2008;23(2):181-7. doi: 10.1007/s00384-007-0393-9.
29 Doll D, Evers T, Krapohl B, Matevossian E. Is there a difference in outcome (long-term recurrence rate) between emergency and elective pilonidal sinus surgery? Minerva Chir. 2013;68(2):199-205.
30 Doll D, Haas S, Faurschou IK, Hackmann T, Braun-Münker M, Oetzmann von Sochaczewski C, et al. Potential observation bias in Pilonidal sinus studies. 2024.
31 Walsh M, Srinathan SK, McAuley DF, Mrkobrada M, Levine O, Ribic C, et al. The statistical significance of randomized controlled trial results is frequently fragile: a case for a Fragility Index. J Clin Epidemiol. 2014;67(6):622-8. doi: 10.1016/j.jclinepi.2013.10.019.
32 Carlisle JB. False individual patient data and zombie randomised controlled trials submitted to Anaesthesia. Anaesthesia. 2021;76(4):472-9. doi: 10.1111/anae.15263.
33 Carlisle JB. Data fabrication and other reasons for non-random sampling in 5087 randomised, controlled trials in anaesthetic and general medical journals. Anaesthesia. 2017;72(8):944-52. doi: 10.1111/anae.13938.
34 Iesalnieks I, Ommer A, Herold A, Doll D. German National Guideline on the management of pilonidal disease: update 2020. Langenbeck's Arch Surg. 2021:406(8):2569-80. doi: 10.1007/s00423-020-02060-1.
35 Doll D. 5- and 10-year recurrence rate is the new gold standard in pilonidal sinus surgery benchmarking. Med Princ Pract. 2010;19(3):216-7. doi: 10.1159/000285292.
Submetido em:
11/09/2025
Aceito em:
14/11/2025
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