Evaluation treatment modalities of the pilonidal disease

Abstract

Background: The pilonidal disease is a minor surgical pathology that has distressful complications. Many original and newer treatment modalities have been used in its management (including excisional and conservative surgical approaches). However, there is non-consensus on any one of them and the main reason is the significant recurrence rate. The objective of the study was to evaluate the excisional surgical modalities and conservative surgical approach in management the pilonidal disease.Methods: A prospective study enrolled 98 patients (80 males vs. 18 females) with chronic sacrococcygeal pilonidal disease. The ages range is 15-42 years. Group IA were treated by simple excision with primary closure, group IB by simple excision with Z- plasty and group II by conservative surgical approach. The wound complications (wound disruption and infection), length of hospital stays, recurrence rate, patients' satisfaction, and the cosmetic appearance were recorded.Results: The excision and Z-plasy has the least recurrence rate, wound complications rate and average time off work days. The simple excision with primary closure has the highest patient's cosmetic satisfaction. Conservative surgical approach has the worst results (recurrence rate 75%, wound infection rate 65%, 21 days average time off work and two days average length of hospital stay)..Conclusions: The Z-plasty is superior to other methods (has the least recurrence rate). The conservative treatment has non-encouraging results, we recommend it for patients unwilling excisional surgery.