Smoking increases the risk of pre- and postoperative complications in patients with pilonidal disease.
BACKGROUND
Smoking has a negative impact on the natural history and on treatment results of many dermatological conditions. However, there are no data demonstrating a similar effect in patients with pilonidal disease.


METHODS
Consecutive patients undergoing surgery for pilonidal disease between 1/2004 and 3/2012 were analyzed retrospectively. Two surgical methods were used: a minimally invasive "pit-picking" surgery for smaller primary disease and Karydakis flap for patients presenting with larger primary disease or those who have been operated previously. The aim of the present study was to analyze the impact of smoking on the natural history and on treatment results.


RESULTS
Six hundred and ten patients underwent 660 surgeries: 475 pit-picking operations and 185 Karydakis procedures. Smokers had developed a pilonidal abscess at least once during their disease significantly more often than non-smokers (48% vs. 26%, p = 0.00001). The recurrence rate following the pit-picking procedure was significantly increased in smokers (1-year recurrence rate: 36% vs. 21%, p = 0.008). After the Karydakis procedure, smokers developed more wound complications than non-smokers (29% vs. 10%, p = 0.005). The recurrence rate after the Karydakis flap was non-significantly increased in smokers (9% vs. 7% at 1 year, p = 0.07).


CONCLUSIONS
Smoking has a detrimental effect on the natural history and on treatment results of pilonidal disease. Patients should be encouraged to cease smoking prior to pilonidal surgery.
Department of General and Visceral Surgery, Marienhospital Gelsenkirchen, Germany.  i.iesalnieks@marienhospital.eu
Igors
I
Iesalnieks
Department of General and Visceral Surgery, Marienhospital Gelsenkirchen, Germany.
Sina
S
Deimel
Department of General and Visceral Surgery, Marienhospital Gelsenkirchen, Germany.
Carl
C
Zülke
Department of Surgery, University Clinic of Regensburg, Germany.
Hans J
HJ
Schlitt
D000328:Adult; D015984:Causality; D015897:Comorbidity; D062109:Dermatologic Surgical Procedures / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data; D010864:Pilonidal Sinus / Q000175:diagnosis / Q000453:epidemiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology*; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012907:Smoking / Q000453:epidemiology*; D013524:Surgical Flaps / Q000706:statistics & numerical data*; D016896:Treatment Outcome