BMJ  2008;336:975-976 (3 May), doi:10.1136/bmj.39563.485000.80

Letters

Surgery for pilonidal disease

Articles point to the creation of a cartel

The first 150 words of the full text of this article appear below.

It seems that Bascom, an enthusiast for the distinctly unproven hair follicle theory, has been "suckered" into believing that the midline wound in pilonidal sinus surgery is the cause of the problem.¹ McCallum et al’s analysis of a rag bag of papers includes, disgracefully, some that reached their conclusions on the basis of telephone follow-up.² That’s no way to conduct proper research. Effectively, McCallum et al took a load of apples, oranges, and pears and tried to decide which was the "best" fruit. Fruitless! For example, they inform us that "recurrences after primary closure were higher." Of course they were. It is a much more demanding procedure in which ideally the full extent of the infected pilonidal sinus track needs to be stained and excised meticulously, but rarely is.

Pilonidal sinus surgery demands attention to the precise definition of the extent of the disease, good tissue care, haematoma avoidance, sterility, . . . [Full text of this article]

¹ Bedford Hospital, Bedford MK42 9DJ

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