key: cord-0794803-kijfupv8
authors: Ali, Kiren; Tahir, Ahmed; Chien, Siobhan; Komolafe, Olusegun
title: SP7.1.12 Could surgery under local anaesthetic be the default for Pilonidal Sinus Disease? A systematic review
date: 2021-10-28
journal: Br J Surg
DOI: 10.1093/bjs/znab361.146
sha: 120b4d471e02b7b2383d33755b91a401b21a910d
doc_id: 794803
cord_uid: kijfupv8

AIMS: Pilonidal sinus disease (PSD) is a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of Local Anaesthesia (LA) when compared to spinal or general anaesthesia in individuals undergoing definitive surgery for PSD. METHODS: A systematic review of literature was conducted. Studies included randomized controlled trials comparing LA with other anesthetics and non-randomized studies focusing on ambulatory procedure of excising pilonidal sinus aiming wound closure, all performed under local anesthetics. We used Cochrane risk of bias tool. The statistical analysis was done using Revman and Excel. RESULTS: Four original RCTs and 10 observational studies were included, with a total of 1801 patients. There was no significant difference in operative time between the groups Patients in the local anaesthetic group experienced less pain than those in other group, lower rates of anaesthetic related complications, early return to work and increased satisfaction. However, the mode of anaesthesia used had no relation with recurrence. CONCLUSION: Our findings support the use of LA in adult patients undergoing definitive surgical treatment for PSD. We aggregate the published evidence to demonstrate clear benefits clinically, patients’ preference, and economic benefits. Patient selection, and adequate dose of local anaesthetic, is the key. In the context of the current COVID—19 pandemic, novel care pathways need to be developed in all medical fields, and we would propose that surgery for Pilonidal Sinus Disease under local anaesthesia should now be the default.

SP7. 1.12 Could surgery under local anaesthetic be the default for Pilonidal Sinus Disease? A systematic review Kiren Ali 1 , Ahmed Tahir 1 , Siobhan Chien 2 , Olusegun Komolafe 2 1 University of Edinburgh, 2 Wishaw General Hospital Aims: Pilonidal sinus disease (PSD) is a significant cause of morbidity. The purpose of this systematic review and meta-analysis is to determine the totality of evidence regarding the effectiveness of Local Anaesthesia (LA) when compared to spinal or general anaesthesia in individuals undergoing definitive surgery for PSD. Methods: A systematic review of literature was conducted. Studies included randomized controlled trials comparing LA with other anesthetics and non-randomized studies focusing on ambulatory procedure of excising pilonidal sinus aiming wound closure, all performed under local anesthetics. We used Cochrane risk of bias tool. The statistical analysis was done using Revman and Excel. Results: Four original RCTs and 10 observational studies were included, with a total of 1801 patients. There was no significant difference in operative time between the groups Patients in the local anaesthetic group experienced less pain than those in other group, lower rates of anaesthetic related complications, early return to work and increased satisfaction. However, the mode of anaesthesia used had no relation with recurrence. Conclusion: Our findings support the use of LA in adult patients undergoing definitive surgical treatment for PSD. We aggregate the published evidence to demonstrate clear benefits clinically, patients' preference, and economic benefits. Patient selection, and adequate dose of local anaesthetic, is the key. In the context of the current COVID-19 pandemic, novel care pathways need to be developed in all medical fields, and we would propose that surgery for Pilonidal Sinus Disease under local anaesthesia should now be the default. nerve (6, 5.9%), of which 4(4.0%) had a permanent loss. Additionally, four (4.0%) patients developed salivary fistula whereas (2%) patients developed Frey's syndrome.

Conclusion: Facial nerve injury should be clearly explained, in the consent, to the patient as a medicolegal purpose. Where the nerve stimulator is not available, identification of the proposed anatomical landmarks allows a safe recognition of the facial nerve.

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