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Minimal Excision and Primary Suture is a Cost-Efficient Definitive Treatment for Pilonidal Disease with Low Morbidity: A Population-Based Interventional and a Cross-Sectional Cohort Study
Sahlgrens University Hospital, Sweden.
County Hospital Ryhov, Sweden.
Värnamo Sjukhus, Sweden.
Linköping University, Department of Clinical and Experimental Medicine, Division of Surgery, Orthopedics and Oncology. Linköping University, Faculty of Medicine and Health Sciences. County Hospital Ryhov, Sweden.
2017 (English)In: World Journal of Surgery, ISSN 0364-2313, E-ISSN 1432-2323, Vol. 41, no 5, 1295-1302 p.Article in journal (Refereed) Published
Abstract [en]

Background Conventional treatment of pilonidal disease with wide excision is associated with high morbidity. We describe the short- and long-term results and the impact on the health care system of a simple operation performed in the office under local anaesthesia, consisting of minimal excision of pilonidal sinuses with primary suture-the modified Lord-Millar operation (mLM). Methods All patients operated with mLM from February 2008 till November 2012 were prospectively followed for recurrence by telephone interviews and examination of symptomatic patients till July 2015. The outcome is compared with that in all patients operated with conventional wide excision from January 2003 till February 2008. The effects on the health care system of a consistent use of mLM is analysed by comparing the management of all patients with pilonidal disease at three hospitals during 2013 and 2014. Results Some 129 patients underwent conventional surgical treatment, and 113 had the mLM operation. The mLM operation was more often performed under local anaesthesia, was less often admitted to hospital, had fewer post-operative health care visits (2.4 vs. 14.6, p amp;lt; 0.001) and a shorter sick leave (1.0 vs. 34.7 days, p amp;lt; 0.001) indicating faster wound healing. The estimated 5-year recurrence rate was similar (32 vs. 23%, p = 0.091). The cost per operated patient was lower (2231 vs. 6222 EUR, p amp;lt; 0.001). The hospital consistently applying the mLM operation used less resources for pilonidal diseased patients (34,545 vs. 77,421 EUR per 100,000 inhabitants and year). Conclusions The mLM operation is simple, cost-efficient and has low morbidity and good long-term results.

Place, publisher, year, edition, pages
SPRINGER , 2017. Vol. 41, no 5, 1295-1302 p.
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-137386DOI: 10.1007/s00268-016-3828-zISI: 000399693400021PubMedID: 27905018OAI: oai:DiVA.org:liu-137386DiVA: diva2:1096692
Note

Funding Agencies|Region Ostergotland, and Futurum - the academy for healthcare, Jonkoping county council, Sweden

Available from: 2017-05-18 Created: 2017-05-18 Last updated: 2017-06-14

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