Fibrin Glue: Effective Management for Primary and Recurrent Pilonidal Sinus Disease

Overview

Fibrin glue offers a minimally invasive, rapid treatment option for pilonidal sinus disease (PSD) with high patient satisfaction and quick return to normal activities. This study evaluated its use as a primary treatment and for recurrent cases, demonstrating promising outcomes with minimal tissue loss and low complication rates.

Background

Pilonidal sinus disease is a chronic condition predominantly affecting young males, with an incidence of 26 per 100,000 and a male-to-female ratio of approximately 3:1. Traditional wide excisional surgeries cause significant tissue loss and prolonged healing, while minimally invasive techniques have gained popularity despite higher recurrence rates. Fibrin sealants mimic natural coagulation, promoting tissue healing and have been used in various surgical fields. Their application in PSD aims to reduce recurrence, pain, and recovery time.

Data Highlights

From January 2011 to January 2016, fibrin glue procedures were performed on patients with primary or recurrent PSD. Procedures were done as same-day discharge under general anesthesia (except one local anesthesia case). No antibiotic prophylaxis was given. Patients were followed for at least one year postoperatively. The technique involved curettage of sinus tracts followed by injection of fibrin glue to obliterate the sinus, with no further dressing required. Patients were advised to use oral paracetamol as needed and to resume normal activities within 2–3 days.

Key Findings

• Fibrin glue treatment allows rapid return to normal activities, typically within 2–3 days.
• The procedure is minimally invasive, avoiding significant tissue loss associated with traditional excisional surgeries.
• High patient satisfaction reported due to no requirement for wound care and minimal postoperative pain.
• Fibrin glue promotes physiological clot formation and tissue healing by stimulating macrophages and collagen production.
• Effective for both primary PSD and recurrent cases after previous surgical or glue treatments.
• Low complication rates observed, with no antibiotic prophylaxis needed and minimal wound breakdown.

Clinical Implications

Fibrin glue represents a practical, less invasive alternative to wide excision or flap procedures for PSD, particularly suitable for patients with multiple pits or recurrent disease. Its use can reduce recovery time, postoperative pain, and healthcare costs while maintaining a high cure rate. Clinicians should consider fibrin glue as a first-line or adjunctive treatment in appropriate PSD cases.

Conclusion

Fibrin glue is a rapid, effective, and patient-friendly treatment modality for primary and recurrent pilonidal sinus disease, offering a favorable balance between cure rates and minimal morbidity. Further larger studies may consolidate its role as a standard treatment option.

References

1. Keshava et al. 2010 -- Outcomes of Karydakis procedure
2. Keshvari et al. -- Wound complication rates in PSD surgery
3. Allen-Mersh 1990 -- Ideal treatment criteria for PSD
4. Baxter -- Tisseel Fibrin Glue Product Information
5. Original study group -- Pilot study of fibrin glue in PSD