Impact of spinal versus general anesthesia on postoperative pain and long term recurrence after surgery for pilonidal disease

• Anesthesia has no influence on recurrence rate in pilonidal sinus disease (PSD).
• Posto-perative pain does not differ between general- and spinal anesthesia.
• Due to the higher recurrence rate cryo- and local anesthesia should not be used.

Study objectiveTo assess the effect of the kind of anesthesia on postoperative pain and long term recurrence rate in pilonidal sinus disease.DesignRetrospective study.SettingSurgical departments of German Armed Forces Hospitals in Hamburg, Bad Zwischenahn and Hamm.Patients583 pilonidal sinus disease (PSD) surgery patients operated for pilonidal disease.InterventionInterview of randomly selected patients, who had been followed up to 20 years after PSD surgery.MeasurementsAnalysis of long term recurrence-free survival and postoperative pain scores among patients who received different anesthesia modalities.Main resultsRecurrence occurred in 21.97% of patients who received general anesthesia with intubation (ITN), in 23.32% of spinal anesthesia (SPA), and in 31.91% of local- or cryoanesthesia. Our data indicate that there was no significant difference in recurrence-free time between the types of anesthesia in any of the surgical procedures applied. Pain scores of patients who underwent primary midline closure (4.74 ± 2.63, 95% CI [4.36, 5.12]) were significantly lower than pain scores of patients who underwent marsupialization (6.12 ± 2.71, 95% CI [5.17, 7.07]) or primary open treatment (6.09 ± 2.79, 95% CI [5.79, 6.39]) (P < .0001). Post-operative pain scores did not differ between patients who received ITN or SPA. Cryo- or local anesthesia resulted in significantly lower post-operative pain scores compared to ITN (P = .0089) or SPA (P = .0031).ConclusionThe use of SPA or general anesthesia did not affect the long term recurrence rate in PSD. Postoperative pain experienced either in-hospital or after discharge did not differ between patients receiving ITN or SPA. With other cryo- or local anesthesia, postoperative pain score was significantly reduced in any surgical procedure. However, due to the higher recurrence rate after cryo- or local anesthesia, only SPA and general anesthesia should be applied. The decision whether spinal or general anesthesia is applied in PSD surgery remains a purely anesthesiological decision based on standard considerations.