Turkey is leading in the 21st century pilonidal sinus disease research

Abstract

Objectives: Pilonidal sinus disease (PSD) has been a recognized pathology for the past 188 years. We studied whether scientific interest in this common disease has grown or declined over time. Our investigation included analysis of the world literature between 1833 and 2018.

Material and methods: A PubMed search was conducted to identify all publications on pilonidal sinus disease, broken down by country, year of publication and number of patients included or described.

Results: The number of patients studied has been increasing, with date of more than 10,000 patients published per decade since 1970, and the total number of affected patients exceeding n=40,000 in 2010 and Turkey leads the research, contributing 39% of the Mediterranean patients and 18% of the patients globally, while Italy provides 26% of the Mediterranean patients and 12% of the global total. Flap studies have increased, whereas primary open treatment studies have decreased from 40% in 1940 to less than 10% at present. Twenty percent of the studies performed today report primary median approaches, and the number of randomized controlled trials has increased.

Conclusion: Surgeons in Turkey currently publish the lion´s share of the pilonidal sinus literature.

Keywords: hair; pilonidal sinus; publications; recurrence rate; study size; surgery.

Figure 1. Flow diagram based on preferred reporting items for systematic reviews and meta-analyses (PRISMA) illustrating the systematic search for evidence regarding recurrence and long-term follow-up data associated with common surgical procedures in PSD.

Figure 2. Histogram of pilonidal sinus disease (PSD) study sizes from 1833 to 2018.

Figure 3. Size of published pilonidal sinus studies over time between 1930 and 2010, given as mean ± SEM. Data from 1920 and earlier are too few to calculate average values ± SEM.

Figure 4. Number of published PSD patients according to decade of surgery. Please note that the 2020 value is estimated.

Figure 5. Number of pilonidal sinus disease (PSD) patients in research published between 1833 and 2018, by decade of surgery in different land groups (smoothed over 4 decades).

Figure 6. Percentage use of therapeutic methods by decade of surgery (Percentage depicts percentage of patients with certain therapy; smo- othed over 4 decades).

Figure 7. Percentage of prospective vs. retrospective PSD studies by year of publication, smoothed over 4 decades.