Primary pilonidal sinus repair: the outcome of 5 different techniques. can a modification be near ideal or provide a benefit?

ABSTRACT

Although various surgical treatment procedures for pilonidal sinus disease have been evaluated, no clear agreement has been reached as to which one is optimal for the lower incidence of wound infection, wound dehiscence and recurrence rate, almost certainly because there is none. This study was intended to investigate the outcome among five different selected primary closure techniques and to investigate the possibility of decreasing the operation costs by omitting the subcutaneous suture usage in some primary techniques. Prospective study considering morbidity and recurrence as the main outcome measures. This study included 94 patients 84 male and 10 females with chronic pilonidal sinus disease who were operated on. All underwent excision and primary closure under spinal [64- 61 males, 3 females] or general anaesthesia [30 patients 23 males, 7 females] between May 2004 and February 2007. Patients were prescribed IV prophylactic antibiotic. 5 different techniques were done. They were simple closure technique in the midline, full-thickness z-plasty flap, semi-open, semi-closed closure techniques, musculofascial flap, and the modified musculofascial flap. Early wound complications with delayed wound healing had occurred in seven patients. Two patients had wound dehiscence [one due to haematoma in the modified group and the 2nd due to wound deep infection in the group of musculofascial flap]. A case of seroma occurred in the modified group. Four cases [4.25%] had minor wound breakdown due to superficial wound infections. They were one case in the simple closure method, one in the musculofascial flap, the third in the full thickness z-plasty and the fourth in the modified musculofascial flap procedure. Late postoperative complications One patient suffered from late wound dehiscence in of the modified group due to infected haematoma. Two cases of recurrence had occurred. One of the superficial wound infections in the simple closure technique. The 2[nd] case was that of the deep wound infection in the musculofascial flap no recurrence has occurred in either the full-thickness z-plasty flap, the semi-open, semi-closed closure, or in the modified group.No significant difference in operation time, time of wound healing, time to return work, patient's or surgeon's satisfaction and cost effectiveness. Best treatment is still unclear. A perfect operation for pilonidal sinus disease should be simple with short hospital stay and low recurrence and complication rate associated with minimal pain, cost effective and have short off work time. Judging the results of the different procedures is difficult because there are no enough significant differences to prefer one to other procedures. Further investigations into the whole medical, financial and social aspects of these procedures for the treatment and management of pilonidal disease are still required