How to repair the surgical defect after excision of sacrococcygeal pilonidal sinus: a dilemma

Abstract

Although there are various therapeutic modalities to manage patients suffering from sacrococcygeal pilonidal sinus disease, there remains controversy over a standard method to treat such patients. In this study the postoperative outcomes after three different surgical methods of wound repair in patients with sacrococcygeal pilonidal sinus were compared. Patients were divided randomly into three different groups. All of the patients underwent a wide excision of their pilonidal sinus; the subsequent surgical wound was left open in the first group (lay open group) whereas it was repaired with a simple primary closure and a rhomboid flap in the second and third groups. Variables including length of hospitalisation, time for wound healing, time off work, recurrence and surgical complications were evaluated. A total of 60 patients with an average age of 27.61 years were studied, including 47 (78.3%) men and 13 (21.7%) women. Postoperative hospitalisation time was significantly shorter in patients who were treated using the simple primary closure method than those with the rhomboid flaps. However, there were no differences in terms of postoperative hospitalisation time between the lay open and simple primary groups or the lay open and rhomboid groups. The period of absence from work was significantly shorter in patients who were managed by a simple primary closure or rhomboid flap technique comparing to those whose wound was left open (p<0.05). Complete wound healing had a significantly shorter course in the rhomboid flap and the simple primary closure techniques compared to those within the lay open group. In terms of complications, postoperative infection and haemorrhage were more common in the lay open group than in the other two. Recurrence was about 5% in patients who were treated with the lay open method in an 18-month follow-up period; however, no recurrence was observed in the other two groups. Considering the earlier wound healing period, less days absent from work, lower complication levels and recurrence rates, the simple primary closure or rhomboid flap techniques appear to be better options to treat the subsequent wound after a wide excision of pilonidal sinus when compared to the lay open method. The simple primary closure method causes no cosmetic disfiguration and the most promising option among the three techniques assessed. The authors have declared that no conflict of interest exists.