Table 2. Variables collected from studies included, worldwide. Conservative measures: local care, hair removal, antibiotics local or oral ± the application of prepared solutions (e.g., salt-based solutions) Overweight: BMI of 25-29.9 kg/m², Obese: BMI of 30-39.9 kg/m², Morbid obesity: BMI of more than 40 kg/m², Pre-/Post-Tx: Pre-/Post-therapeutic, SCPNS: sacrococcygeal pilonidal sinus, USA: united states of America, ITP: Idiopathic thrombocytopenic purpura, MRI: Magnetic resonance imaging, US: ultrasound, PCOD: Polycystic Ovarian Disease, ¨ (Group 1; local debridement and systemic antibiotic), (Group 2; local debridement, systemic antibiotic and silver nitrate) and (Group 3; debridement, systemic antibiotic and salt).
| Author | Sample size (total) | Country | Mean age (years/ ± SD) | Male n (%) | BMI (Kg/m2) | Comorbidities | Presenting symptoms | Diagnosis (clinical, radiological or Histo.) | Radiologic findings (Type and finding) | Interventions | Recurrence | Other findings |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Randomized Clinical Trial | ||||||||||||
| Kaplan et al., (2016) [5] | 84 | Turkey | 20.83 ± 5.73 | 79 (94) | 24.39 ± 3.5 | Umbilical discharges, pain, itching, and malodor | Clinical | No | Conservative measures (n=42) Surgical (Umbilectomy) (n=42) |
Pre-Tx: 37% Post-Tx: 10 in the conservative group. Post-Surgical: 1 |
Cure (68.3% in conservative group vs 100% in the surgical group; p < 0.0001). The surgical approach had lower total financial cost, a higher satisfaction rate after 1 month, and a lower re-admission rate. |
|
| Cohort studies | ||||||||||||
| Isik et al., (2022) [6] | 82 | Turkey | 23.24 | 63 (76.8) | N\A | 20.7 % had SCPNS | Umbilical discharge and pain | Clinical and radiological | US: N\A | conservative measures (63.4%), surgical (30.5%), and silver nitrate treatment was added in (6.1%) | Post-Tx: 9 had recurrence. | Smoking was the only modifying factor for recurrence, reduced the odds of healing by 96%. |
| Muhialdeen et al., (2023) [7] | 114 | Iraq | 23.24 | 82 (71.9) | 26.5 | Concurrent SCPNS in 18 patients (15.8%). |
Umbilical pain (82, 71.9%), itching (67, 58.8%), and discharge (52, 45.6%). | Clinical | No | Conservative measures | Pre-Tx: 6 Post-Tx: 1 |
Used a mixture of petroleum jelly, henna powder and tetracycline into the umbilicus. (100, 87.7%) had a single sinus |
| Sözen et al., (2015) [8] | 56 Group 1= 20 Group 2= 18 Group 3= 18 |
Turkey | Group 1= Mean: 25.22 Group 2= Mean: 28.34 Group 3= Mean: 23.18 |
46 (82.14) | 31 (overweight) 22 (obese) 3 (morbid obesity) |
N\A | Pain, discharge, local induration, and bleeding | Clinical | N/A | Conservative measures¨ | Pre-Tx: Group 1: 8 Group 2: 5 Group 3: 9 Post-Tx: Group 1: 4 Group 2: 2 Group 3: 1 |
The least recurrence was in the salt application group. |
| Eryilmaz et al., (2010) [9] | 26 | Turkey | 22 | 24 (92) | 4 (obese) | 6 patients had hyperhidrosis | Umbilical pain, Bloody discharge, Purulent discharge, Umbilical mass and Redness | Clinical and Post-excisional Histopathology [The sinus contained hair shafts, epithelial debris, keratin, and chronic inflammatory infiltrate] |
N/A | Conservative measures (n=25) Surgical: 1 (um bilectomy). |
Post-Tx: 2 (underwent surgical management) | |
| Kareem, (2012) [10] | 134 | Iraq | 24.14 | 121 (90.15) | 24.07 ± 2.11 | 4 patients have history of SCPNS | Pain, discharge (purulent, bloody, both), Redness, swelling, Pruritus, Bad odor, and Fever. | Clinical | No | Conservative measures (3 required Umbilectomy) | None | On clinical examination 40 (29.85 %) of them had asymptomatic SCPNS. Improper extraction of hair is the main cause of failure of conservative treatment. |
| Abdelnour et al., (1994) [11] | 27 | Lebanon | 26 | 26 (96.2) | N/A | N/A | N/A | Clinical | N/A | Conservative measures | Post-Tx: 4 | Cure reached 98% after 2 years |
| Fazeli et al., (2008) [12] | 45 | Iran | 22.6 | 39 (86.5) | N\A | 6 patients had synchronous SCPNS | Bloody or purulent umbilical discharges | Clinical | No | Surgical (Sinus Excision with Umbilical Reconstruction) |
None | The satisfaction rate after reconstruction was 80% |
| Coşkun et al., (2010) [13] | 31 | Turkey | 24.38 | 27 (87) | 23.89 | N\A | Umbilical pain, Purulent discharge, Swelling and scaling | Clinical | N\A | Conservative measures In refractory cases or in case of recurrence, surgical intervention was made (umbilectomy) |
N\A | Control and patient groups’ variables were correlated to UPS and age, profession, status hirsutism, family history of PS, wearing tight clothes and BMI were significant (P<0.05). |
| Huda et al., (2018) [14] | 15 | India | N\A | 13 (86.7) | N\A | One female patient with PCOD | Umbilical discharge, Periumbilical pain, swelling and Bleeding. | Clinical (otoscopic findings) | No | Conservative measures | None | - |
| Sarmast et al., (2011) [15] | 51 | Iran | 25.75 ± 8.74 | 35 (68.6) | N\A | N\A | N\A | N\A | N\A | Conservative measures (n=43) Surgical: 8 (Umbilectomy) |
N\A | 84.31% of cases responded well to Conservative measures. |
| Case Reports | ||||||||||||
| Kaplan et al., (2017) [16] | 2 | Turkey | 23.5 | 1 (50) | N\A | N\A | Periumbilical Pain, Swelling, Malodorous discharge, dermatitis and Pruritus | Clinical | No | Umbilicus preserving excisional surgery | None | Both patients failed conservative management |
| Hsu et al., (2023) [17] | 1 | USA | 15 | 1 (100) | N\A | ITP | Chronic umbilical infections, pain, Serosanguinous discharge and Umbilical granuloma | Clinical and radiological | US: a solitary ovoid lesion consistent with an umbilical granuloma. MRI: thickening of the umbilicus and adjacent tissue. No patent urachal tract or hernia. |
Surgical (modified GIPS technique) |
Recurrence approximately one year later. Re-excision and packing was done. |
|
| Mallin et al., (2016) [18] | 1 | Antigua | 41 | 1 (100) | N\A | No | Umbilical Discharge and Mild discomfort while wearing a belt | Clinical | No | Conservative measures (used Cryocone for umbilical visualization) |
None | - |
| Kabay et al., (2009) [19] | 1 | Turkey | 26 | 1 (100) | N\A | No | Umbilical pain, Swelling, Discharge and Bleeding | Radiological and histopathological: The hair shaft penetrates into the dermis and elicits a foreign-body giant cell reaction. |
Fistulography: a cavity of 4x4 cm and a tract leading from the cavity to the umbilicus. | Surgical (Umbilectomy) | N\A | |
| Mantoğlu et al., (2021) [20] | 1 | Turkey | 37 | 1 (100) | N\A | N\A | Generalized abdominal pain and tenderness | Clinical and radiological | US: Showed free fluid in Morison's pouch. | Surgical (UPS excision with preserving the umbilicus) | N\A | |
| Meher et al., (2016) [21] | 2 | India | 18.5 | 2 (100) | N\A | N\A | Umbilical pain and discharge | Clinical | No | Conservative measures | None | |
| Naraynsingh et al., (2009) [22] | 1 | West Indies (Trinidad) | 22 | 1 (100) | N\A | No | Recurrent, Umbilical intermittent purulent discharge and Itching | Clinical | No | Surgical (UPS excision with preserving the umbilicus) | Post-surgery: None | |
| Othman et al., (2022) [23] | 1 | Australia | 62 | 1 (100) | N\A | N\A | Umbilical pain and purulent discharge | Clinical and radiological Histopathology: extensive ulceration and granulation tissue. |
US: an isoechoic ovoid focus measuring 8x9 x7 mm, but no obvious hernia. | Surgical (UPS excision with preserving the umbilicus) | Pre-Surgery with conservative measures: Yes Post-surgery: N\A |
|
| Bogdanic, (2022) [24] | 1 | Croatia | 36 | 1 (100) | 25.1 | N\A | Occasional Umbilical pain, wetness, swelling, and discharges. | Clinical | No | Surgical (Laser Ablation at 1470 nm wavelength, and power of 12 W. A total of 280 J was applied) | None | |
| Savant, (2024) [25] | 1 | India | 26 | 1 (100) | N\A | Obese | Umbilical foul smelling purulent discharge and swelling. | Clinical Histopathology: a central sinus tract with multiple hair follicles surrounded by dense chronic inflammatory infiltrate and congested vessels |
No | Surgical (everted UPS Punch excision followed by chemical cauterization with 88% phenol) | None | |
| Gupta et al., (1990) [26] | 2 | India | 24 | 2 (100) | N\A | N\A | Recurrent umbilical pain and purulent discharges. | Clinical Histopathology: fibrosis with chronic inflammatory cells and the lumen was packed with necrotic debris and a few hairs. |
No | Surgical (Umbilectomy) | None | |
| Patey et al., (1956) [27] | 1 | India | 26 | 1 (100) | N/A | N/A | Umbilical purulent discharges | Clinical Histopathology: granulation tissue and hair, no epithelium/sebaceous glands or hair follicles. |
No | Surgical (Umbilectomy) | None | |
| Martin, (1962) [28] | 1 | USA | 19 | 1 (100) | N/A | Concurrent SCPNS | Umbilical pain and hair protrusion | Clinical Histopathology: chronic inflammatory tract with hair follicles lining it and epithelium. |
No | Surgical (Umbilectomy) | None | |