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Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Objective

To study the potential benefits of intraoperative methylene blue (MB) use in pilonidal sinus surgery, the correlation between long-term recurrence rate and intraoperative MB use in pilonidal sinus surgery was investigated.

Background

Explicit investigations of MB effects in sinus surgery are scarce and inconclusive; an effect on long-term recurrence rate has never been systematically investigated.

Materials and methods

A random selection of 247 patients out of 1,960 patients with primary sinus surgery was drawn, and the patients were subjected to a telephone interview according to a specific questionnaire. The interview covered a recurrence follow-up time of 14.9 years after surgery (mean, standard deviation=3.8 years, range 8.6–25.4 years).

Results

Recurrence was less likely to occur when MB was used intraoperatively (32 of 197, [16% actuarial 20-year recurrence rate, Kaplan–Meier estimate] recurrences with MB vs 15 of 50, 30% [actuarial 20-year recurrence rate, Kaplan–Meier estimate] recurrences without MB; p=0.018; log-rank test). This effect was especially pronounced in acute abscess-forming disease (8 of 46, 17% [actuarial 20-year recurrence rate, Kaplan–Meier estimate] recurrences with MB; 11 of 33, 33% [actuarial 20-year recurrence rate, Kaplan–Meier estimate] recurrences without MB; p=0.078; log-rank test) compared to chronic disease (24 of 151, 16% [actuarial 20-year recurrence rate, Kaplan–Meier estimate]) recurrences with MB; 4 of 17, 24% [actuarial 20-year recurrence rate, Kaplan–Meier estimate] recurrences without MB; p=0.35; log-rank test).

Conclusions

MB application halves the long-term risk of recurrence for pilonidal sinus patients. This significant reduction in recurrence rate can be achieved by a single careful injection of non toxic inexpensive dye into the sinus at the start of the operation. MB application should therefore be considered as an integral part of pilonidal sinus surgery.

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Abbreviations

OR:

odds ratio

MB:

Methylene Blue

PSD:

pilonidal sinus disease

RR:

recurrence rate

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Acknowledgement

This work would not have been possible without the continuous support of Dr. Heidi Dettmann, who is one of the architects of our large and living database.

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Authors and Affiliations

  1. Medical School, Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa

    Dietrich Doll

  2. Department of Surgery, Armed Forces Hospital Berlin, Berlin, Germany

    Dietrich Doll, Ronny Rothe, Kai Wietelmann & Wolfgang Düsel

  3. Klinikum rechts der Isar, Department of Surgery, Technical University of Munich, Ismaninger Street 22, 81675, Munich, Germany

    Dietrich Doll & Alexander Novotny

  4. International Non-Antibiotic Research Group, Department of Research and Microbiology, University of Southern Denmark, Sønderborg, Denmark

    Jette Elisabeth Kristiansen

  5. Institute for Medical Statistics and Epidemiology, Technical University of Munich, Munich, Germany

    Anne-Laure Boulesteix

  6. Department of Surgery, Bethesda General Hospital Hamburg Bergedorf, Hamburg, Germany

    Sven Petersen

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  1. Dietrich Doll
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  2. Alexander Novotny
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  3. Ronny Rothe
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  4. Jette Elisabeth Kristiansen
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  7. Wolfgang Düsel
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Correspondence to Dietrich Doll.

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Doll, D., Novotny, A., Rothe, R. et al. Methylene Blue halves the long-term recurrence rate in acute pilonidal sinus disease. Int J Colorectal Dis 23, 181–187 (2008). https://doi.org/10.1007/s00384-007-0393-9

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  • DOI: https://doi.org/10.1007/s00384-007-0393-9

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