Fibrin sealant use in pilonidal sinus: Systematic review

Table 1 Studies of fibrin sealant at pilonidal sinus: Demographics of the patients

Ref.	Year	Country	Study period	No.	Male	Age	BMI or weight
Greenberg et al[4]	2004	Israel	Jun 2001 to Dec 2001	30	22	23.5 ± 2.8 (17-44)	NA
Lund et al[5]	2005	United Kingdom	NA	6	6	28.5 ± 5.5 (22-44)	NA
Seleem et al[6]	2005	Saudi Arabia	Sep 2001 to Feb 2004	25	23	26.4 ± 8.5 (17-50)	NA
Patti et al[7]	2006	Italy	NA	8	8	21.8 ± 6.5	NA
Altinli et al[8]	2007	Turkey	Jan 2003 to Jan 2004	16	16	24.5 ± 6.0	25.7 + 4.1 kg/m2
Sözen et al[9]	2011	Turkey	Jan 2008 to Mar 2008	25	25	22.5 ± 4.0 (20-36)	26 kg/m2
Elsey et al[10]	2013	United Kingdom	Mar 2007 to Sep 2011	57	42	26.0 ± 13.3 (17–70)	NA
Isik et al[11]	2014	Turkey	Dec 2007 to Dec 2011	40	32	24.0 ± 8.5 (16-50)	NA
Smith et al[12]	2014	United Kingdom	Aug 2006 to Dec 2013	10	NA	14.5 ± 1.0 (12–16)	73 kg
Total			Jun 2001 to Dec 2013	217	84%	24.2 ± 7.8 (12-70)

BMI: Body mass index; NA: Not available.

Table 2 Studies of fibrin sealant at pilonidal sinus: Features of the pilonidal sinuses

Ref.	No.	Inclusion and exclusion criteria	Recurrent
Greenberg et al[4]	30	No exclusion criteria	8
Lund et al[5]	6	3-4 openings and no large cavity	3
Seleem et al[6]	25	1-3 openings, no prior surgery, no infection	0
Patti et al[7]	8	3 < openings, no prior surgery, no infection, no large cavity or distant orifice	0
Altinli et al[8]	16	No prior surgery	0
Sözen et al[9]	25	No prior surgery, no infection, no lateral extension < 3 cm	0
Elsey et al[10]	57	No infection, no very scarred cases due to repeated episodes or surgeries	2
Isik et al[11]	40	Only 1 opening, no prior surgical or medical treatment, no infection	0
Smith et al[12]	10	No exclusion criteria	0
Total	217		13 (6%)

Table 3 Studies of fibrin sealant at pilonidal sinus: Procedures

Ref.	No.	Surgical procedure	Aim of using fibrin sealant
Greenberg et al[4]	30	Excision and primary closure	Obliterate the dead space under the wound
Lund et al[5]	6	No sinus excision, only cleaning the tracts	Fill the tracts with sealent
Seleem et al[6]	25	Excision and lay open	Overlap the open wound with sealent
Patti et al[7]	8	Excision and lay open	Overlap the open wound with sealent
Altinli et al[8]	16	Excision and closure with Limberg flap	Obliterate the dead space under the wound
Sözen et al[9]	25	Excision and closure with Karydakis flap	Obliterate the dead space under the wound
Elsey et al[10]	57	No sinus excision, only cleaning the tracts	Fill the tracts with sealent
Isik et al[11]	40	No sinus excision, only cleaning the tracts	Fill the tracts with sealent
Smith et al[12]	10	No sinus excision, only cleaning the tracts	Fill the tracts with sealent

Table 4 Surgical details

Ref.	No.	Anesthesia	Amount of glue	Drain
Greenberg et al[4]	30	General or spinal	2-4 mL	None
Lund et al[5]	6	General	1-2 mL	None
Seleem et al[6]	25	Local (n = 23), general (n = 2)	NA	None
Patti et al[7]	8	Local	1.9 ± 0.6 mL	None
Altinli et al[8]	16	Spinal	6 mL	Yes
Sözen et al[9]	25	NA	6 mL	None
Elsey et al[10]	57	General	NA	None
Isik et al[11]	40	Local	2-4 mL	None
Smith et al[12]	10	General	NA	None
Total	217	Local 39%	3.8 (1-6)	7.3%

NA: Not available.

Table 5 Obliterating the dead space under the closed wound with sealent

Ref.	No.	Closure method	Return to normal activities	Complications	Mean follow-up (mo)	Recurrence
Greenberg et al[4]	30	Primary	11.0 + 6.0 d	Purulent discharge (n = 4)	23.0 ± 3.0	None
Altinli et al[8]	16	Limberg	NA	None	8.5	None
Sözen et al[9]	25	Karydakis	NA	Fluid collection (n = 6)	10.2	None
Total	61			10 (16.4%)	15.2	None

NA: Not available.

Table 6 Studies on covering the open wound with fibrin sealant after excision

Ref.	No.	Healing time	Morbidity	Satisfaction	Recurrence
Seleem et al[6]	25	2 wk	1	84%	None
Patti et al[7]	8	25.8 ± 13.2 d	1	100%	None
Total	33	16.9 d	2 (6%)	88%	None

Table 7 Studies on filling the tracts with fibrin sealant

Ref.	No.	Work off	Morbidity	Pain	Follow-up
Lund et al[5]	6	NA	None	None	18 mo
Elsey et al[10]	57	Median 6	None	None	23 mo
Isik et al[11]	40	Mean 2.0 ± 1.0	None	32	18 mo
Smith et al[12]	10	NA	1 (infection)	1	32 mo
Total	113	Usually < 7	0.9%	33 (29%)	21.7 mo

NA: Not available.