Fibrin sealant use in pilonidal sinus: Systematic review

Abstract

Aim: To review the current data about the success rates of fibrin sealant use in pilonidal disease.

Methods: Fibrin sealant can be used for different purposes in pilonidal sinus treatment, such as filling in the sinus tracts, covering the open wound after excision and lay-open treatment, or obliterating the subcutaneous dead space before skin closure. We searched Pubmed, Google-Scholar, Ebsco-Host, clinicaltrials, and Cochrane databases and found nine studies eligible for analysis; these studies included a total of 217 patients (84% male, mean age 24.2 ± 7.8).

Results: In cases where fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complication rates (9.8% vs 14.6%, P = 0.48). In cases where sealant was used to cover the laid-open area, the wound healing time and patient comfort were reported better than in previous studies (mean 17 d, 88% satisfaction). When fibrin sealant was used to fill the sinus tracts, the recurrence rate was around 20%, despite the highly selected grouping of patients.

Conclusion: Consequently, using fibrin sealant to decrease the risk of seroma formation was determined to be an ineffective course of action. It was not advisable to fill the sinus tracts with fibrin sealant because it was not superior to other cost-effective and minimally invasive treatments. New comparative studies can be conducted to confirm the results of sealant use in covering the laid-open area.

Keywords: Evidence base medicine; Fibrin sealant; Pilonidal disease; Systematic review.

Figure 1

Flowchart of the systematic review.

Figure 2

Obliterating the dead space under the closed wound with sealent vs controls: Meta-analysis of the wound complications.

Figure 3

Filling the tracts with fibrin sealant; meta-analysis of the recurence rates.