Comparative Study between Excision with Primary Closure versus Flap Reconstruction in Management of Sacrococcygeal Pilonidal Sinus

Abstract

Introduction and aim: Pilonidal sinus (PNS) is a common inflammatory condition of the gluteal region. Different methods were introduced for treatment. However, recurrence is still a significant problem after surgery and different approaches were described to lower the recurrence rate. But controversy exist regarding the standard surgical intervention. The current work aimed to compare between excision with off midline primary closure versus Limberg flap procedure in the treatment of sacrococcygeal PNS.
 Methodology: Sixty patients with PNS were included and divided into two equal groups, the first for primary midline excision with closure, and the second treated by Limberg flap. Patients were assessed by clinical evaluation and after surgery, the recurrence rate was documented through the first year. In addition, complications rate and times to restore the normal daily activities were documented and compared between groups.
 Results: Both groups were comparable regarding all preoperative variables. The operative time was significantly short among group I than group II (31.6± 6.5 vs 51.6± 6.4 minutes). The duration of hospital stay, time to return to work, drainage amount, time to stitch removal, time to walk pain-free and time to painless toilet seat were significantly shorter in group I. However, cosmetic score was significantly higher in group I than group II. Finally, the recurrence rate was significantly higher in group I than group II (20.0% vs 0.0%). The recurrence was significantly associated with hairy skin, positive family history, diabetes mellitus, higher BMI, and history of previous PNS.
 Conclusion: Primary midline closure of PNS is superior than the Limberg flap in operative time and times to return to normal daily activities. However, it had a higher recurrence rate. Thus, Limberg flap is advocated for PNS.