Negative Pressure Wound Therapy or Conventional Dressing? A Systematic Review and Meta-Analysis for Wound Therapy in Excision Surgeries for Pilonidal Disease
Marcelo Albuquerque Barbosa Martins, Lucas Monteiro Delgado, Guilherme Franceschini Machado, Rachid Eduardo Noleto da Nobrega Oliveira, Jorge Eduardo Persson, Agata Grochowska, Rafael dos Santos Borges, Vincent de Parades, Fernanda Bellotti Formiga, Steven D. WexnerBackground
Pilonidal disease is a debilitating condition which is caused by an inflammatory process due to the penetration of a hair into the sacrococcygeal region. Negative pressure wound therapy (NPWT) has been growing in several types of surgical wounds; however, the evidence for its use in excision surgery for pilonidal disease is still small and heterogeneous. We conduct a systematic review and meta-analysis comparing this wound closure approach.
Methods
PubMed, Embase, and Cochrane Library databases were searched from inception to December 2025 to identify studies comparing excision surgery of sacrococcygeal pilonidal disease with NPWT and this surgical technique without NPWT. Statistical synthesis was performed using a random effects model, with results expressed as risk ratios (RRs) and mean differences (MDs) with their 95% confidence intervals.
Results
Five studies in which 244 patients were reported in our analysis; 123 (50.4%) underwent NPWT and 121 (49.6%) underwent conventional dressings. Complete healing time was significantly shorter in the NPWT group compared with conventional dressing, both RCT analyses (MD: −15.88 days; 95% CI: −30.04 to −1.72), observational studies (MD: −31.39 days; 95% CI: −55.03 to −7.75), and overall analysis (MD: −24.02 days; 95% CI: −40.75 to −7.29). There was no statistical difference in terms of recurrence (RR: 0.71; 95% CI: 0.15-3.36) and postoperative infection (RR: 0.50; 95% CI: 0.20-1.25).
Conclusion
Negative pressure wound therapy may shorten healing time following open excision for pilonidal disease, but the available evidence remains limited, heterogeneous, and methodologically weak.