Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
Directorate of General Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Colorectal Dis. 2023 Oct;25(10):2010-2016. doi: 10.1111/codi.16696. Epub 2023 Aug 15.
Pilonidal sinus is a common surgical condition which impacts a young and economically active population. There are limited data to guide treatment in this condition. The aim of this work was to assess current practice.
A survey was developed as part of the PITSTOP study. It included questions on volume of practice, treatment preferences and training. The survey was delivered to consultant surgeons with a UK practice through social media, specialty surgical societies and through PITSTOP sites. Descriptive statistics were reported.
Of the 200 people who received a link to the questionnaire, 109 completed it (response rate 54.5%). Respondents treated a median of 15 patients per year, with 20% of these having recurrent disease. Estimates of recurrence were higher than reported in the literature and higher than in a survey 10 years ago. Nearly 50% of surgeons advocate nonsurgical treatment in some patients despite limited evidence. Two thirds practised interventions not favoured by guidelines, including excision and leave open and midline closure techniques. Invasive procedures tended to be favoured when minimally invasive procedures may be appropriate. Surgical training programmes were the key training setting for commonly offered procedures, with few other training opportunities reported. For some procedures, no formal training had been given.
This survey highlights issues with quality in pilonidal surgery in the UK, with persistence of potentially outdated techniques, no consistent treatment escalation plan, a suggestion of under- or overtreatment of disease and a high perception of failure. This may relate to the current system of training and lack of evidence-based guidance.
藏毛窦是一种常见的外科疾病，主要影响年轻且活跃于经济领域的人群。目前针对这种疾病的治疗方法有限，本研究旨在评估当前的治疗现状。
该研究作为 PITSTOP 研究的一部分，设计了一份调查问卷，其中包括手术量、治疗偏好和培训等问题。通过社交媒体、专业外科协会和 PITSTOP 网站向英国从业的顾问外科医生发送了调查问卷。报告了描述性统计数据。
在收到问卷链接的 200 人中，有 109 人完成了问卷（应答率 54.5%）。受访者每年平均治疗 15 例患者，其中 20%的患者患有复发性疾病。估计的复发率高于文献报道，也高于 10 年前的一项调查。尽管缺乏证据，近 50%的外科医生仍建议对部分患者采用非手术治疗。超过三分之二的医生采用指南不推荐的干预措施，包括切开引流和中线关闭技术。微创手术可能适用时，更倾向于采用侵入性手术。手术培训计划是最常见手术的主要培训场所，报告的其他培训机会很少。对于一些手术，没有进行过正规培训。
本调查强调了英国藏毛窦手术质量存在的问题，包括潜在的过时技术仍然存在、缺乏一致的治疗升级计划、对疾病的治疗不足或过度以及对失败的高感知度。这可能与当前的培训体系和缺乏循证指导有关。
