Has the procedure of choice for chronic pilonidal sinus disease finally been found?

Dear Sir, We read, with interest, the article by Newman et al. [1] regarding the feasibility of laparoscopic colorectal resection (LCR), reporting data from two units with declared specialist interest in laparoscopic colorectal surgery. However, we were surprised by the conclusion that the majority of colorectal resections should require, or necessitate, open surgery. Recent data from the National Colorectal Cancer Audit 2011 have shown that currently in the UK only just under 30% of colorectal cancer resections are completed laparoscopically [2]. This slow uptake highlights some of the current difficulties in laparoscopic service provision and development, including the bottleneck in mentored training for existing consultants and the limited training opportunities for surgical trainees. We examined our own practice in a District General Hospital setting within a specialist colorectal unit. We reviewed all colorectal resections performed by two consultant teams between January 2010 and December 2011. In total, 190 consecutive cases were included, 112 (59.0%) for cancer and 78 (41.0%) for benign disease. Of the 190 patients, 140 (73.7%) had elective surgery and 50 (26.3%) had emergency surgery. Laparoscopic surgery was attempted in 142 ⁄ 190 (74.7%) and 15 ⁄ 142 (10.6%) were converted to open surgery (using strictly the same definition for conversion as Newman et al. [1]). Therefore, 89.4% of the LCRs were successfully completed laparoscopically and overall 69% of all colorectal resections during this period were performed laparoscopically. We have also been enrolling patients into the EnROL trial [3]; eight patients were randomized to open surgery, which if excluded, would give an overall LCR rate of 70%. We commend our colleagues’ openness in the reporting of their figures, which highlight the challenges of LCR, even in expert hands. Although laparoscopic rates of 90% and conversion rates of 10% may not be universally achievable, significantly higher overall LCR and lower conversion rates than those presented by Newman et al. [1] are realistic and feasible. We are confident that the uptake of laparoscopic colorectal surgery in many UK units has already surpassed the figures presented by Newman et al. [1] and will continue to rise nationally with the ongoing efforts to train surgeons in this approach. Therefore, we feel that the potentially outdated figures presented in this article should not be used as evidence to support an attitude of resignation to low LCR and comparatively high conversion rates.