Surgical treatment of the pilonidal disease - primary closure or flap reconstruction after excision

ABSTRACT

Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease in terms of recurrence rate and patient discomfort. The present study analyses the results of excision with primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease. From January 2003 to January 2006, 60 consecutive patients with primary pilonidal sinus disease received surgical treatment in the form of either excision and primary closure [group 1,20 patients] or excision and flap reconstruction [group II, 40 patients 20 with modified Limberg flap, 10 with classical Limberg flap and 10 with adipo-fascio-cutaneous flap]. Times for complete healing and return to work were recorded. To evaluate patient comfort, all patients were asked to complete a questionnaire including visual analogue scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery. Mean follow-up was 21 months. There was a significant difference between the two groups in terms of length of hospital stay [P <0.003], time to complete healing [P < 0.001], time off work [P < 0.001], wound infection and recurrence rates [P <0.01], times to sitting on toilet without pain [P < 0.002], and walking without pain [P < 0.001]. The mean postoperative visual analogue scale scores were 6.1 +/- 1.2 in primary closure group versus 7.4 +/- 1.3 in flaps groups [P < 0.001]. In the modified Limberg flap, there was no wound infection, no wound breakdown and no recurrence of the disease. Flaps reconstructions are superior to primary closer after excision of pilonidal sinus and that modified Limberg flap is far better as regards wound infection and recurrence