Published online Mar 27, 2016. doi: 10.4240/wjgs.v8.i3.266
Peer-review started: September 1, 2015
First decision: September 29, 2015
Revised: December 12, 2015
Accepted: January 5, 2016
Article in press: January 7, 2016
Published online: March 27, 2016
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.
Core tip: Fibrin sealant use in pilonidal disease treatment may involve filling in the sinus tracts, covering the laid-open area after excision, or obliterating the subcutaneous dead space before skin closure. This systematic review demonstrates that when the fibrin sealant was used to obliterate the subcutaneous dead space, there was no reduction in wound complications. It was unadvisable to fill the sinus tracts because it was not superior to the other more cost-effective treatments with a 20% recurrence rate. More studies are necessary for sealant use in covering the laid-open area, which has promising results, predicting shorter wound healing time and increased patient satisfaction.