_______
BJS, https://doi.org/10.1093/bjs/znae237, published 14 October 2024
_______
Dear Editor,
We write to express our concern that the recently published European Reference Centre guideline on pilonidal sinus disease (PSD) in BJS falls short of its promise to “…act as a resource for patients…” and provide a “…set of recommendations for clinicians….”1
The authors assert a “…robust set of clinical recommendations…” following a “…rigorous review of the literature…” despite acknowledging an “almost universal poor methodology of the literature.” However, several methodological inconsistencies are evident:
Recurrence as a Function of Time: Recurrence rates should be reported with corresponding follow-up times2—a point inconsistently applied in the guideline.
Misrepresentation of Literature: Stauffer et al. clearly demonstrate that minimal intervention recurrence rates exceed flap procedures at 60 months2, contrasting the guideline’s interpretation. New data support higher recurrence rates after minimally invasive methods (Figure 1).
Speculative Claims: The guideline suggests that asymptomatic disease may resolve spontaneously, despite histological evidence of chronic infection in resected asymptomatic PSD specimens3, contradicting this claim.
Furthermore, the guideline speculates on the incidence of adolescent PSD, attributing it to factors such as obesity and sedentary lifestyles, while ignoring evidence suggesting prepubescent recurrence operates through distinct mechanisms.4, 5 The unfounded emphasis on hygiene, obesity, and lifestyle factors as recurrence predictors, without substantiated evidence, risks misleading clinicians and patients alike.
In conclusion, while aiming high, this guideline lacks comprehensive knowledge, includes inaccuracies, and perpetuates unsupported assumptions.
Figure 1
Recurrence rate and follow-up time for different therapies, analyzing n = 116,673 patients of cohort studies. The Karydakis 1992 study is excluded because of inaccuracies published elsewhere.
References
Ojo D, Gallo G, Kleijnen J, Haas S, Danys D, Dardanov D, Pellino G, Jongen J, O'Shea K, Basso L, Christou N, De Nardi P, Brown S, Senapati A. European Society of Coloproctology guidelines for the management of pilonidal disease. Br J Surg 2024;111: znae237.
Stauffer VK, Luedi M, Kauf P, Schmid M, Diekmann M, Wieferich K, Schnüriger B, Doll D. Common surgical procedures in pilonidal sinus disease: a meta-analysis, merged data analysis, and comprehensive study on recurrence. Sci Rep 2018;8: 1-28.
Doll D, Friederichs J, Boulesteix AL, Dusel W, Fend F, Petersen S. Surgery for asymptomatic pilonidal sinus disease. Int J Colorectal Dis 2008;23: 839-844.
Bosche FD. Physikalische und morphologische Haarcharakteristika von Pilonidalsinuspatienten und ihren Vergleichsprobanden. Dissertation zur Erlangung des Grades eines Doktors der Medizin [Dissertation]. Homburg / Saar: Universität des Saarlandes; 2017.
Oetzmann von Sochaczewski C, Doll D. Recurrence Rates of Pilonidal Sinus Disease Are High in Children and Recurrences Occur Exceedingly Early. Surgeries 2024;5: 726-737.
