Minimally invasive surgery for Pilonidal Disease: outcomes of the Gips technique - a systematic review and meta-analysis

Abstract

Aim Pilonidal disease is a common inflammatory condition with significant impact in the quality of life. Currently, there is a tendency to favour minimally invasive procedures. The present review aims to summarize evidence and assess outcomes of the Gips procedure. Methods: A systematic review was conducted on MEDLINE/Pubmed, Scopus, Web of Science and Cochrane Library databases until December 2022. Eligible studies included patients with pilonidal disease submitted to the Gips procedure, reporting at least one of the following outcomes: wound complications, wound healing time, time to resume daily activities and recurrence (PROSPERO protocol: CRD42023389269). The National Institutes of Health assessment tool was used to evaluate the risk of bias. Meta-analysis was performed using OpenMeta[Analyst] and R softwares and a subgroup analysis was performed, when applicable. Results: Thirteen studies, including seven cohorts and six case series, with a total of 4,286 patients submitted to Gips were included. The pooled wound complications rate was 7.8% (95% CI: 5.1-10.6), mean time to resume daily activities was 1 day (95% CI: 1-2) and mean wound healing time was 4.7 weeks (95% CI: 3.0-6.4). Subgroup analysis showed pooled recurrence rate was 6.5% (95% CI: 5.2-7.8) up to 2 years and 38.9% (95% CI: 27.1-50.7) after more than 2 years of surgery. Most results showed substantial heterogeneity across studies. Conclusion: Despite apparent favourable outcomes of the Gips procedure, there is a high recurrence rate overtime. Since included studies had an observational nature and unstandardized methodologies, comparative randomized controlled trials with longer follow-up are needed.