Abstract
Objectives: Different surgical techniques, with variable morbidity and recurrence rates, have been advocated for the management of chronic pilonidal sinus (PNS). This study was conducted to report the outcome of surgical treatment of 634 cases of chronic PNS at a single institute between January 2001 and January 2010. Methods: Karydakis flap was performed in 244 patients (38.5%, Group 1). Excision and midline closure was performed in 371 patients (58.5%, Group 2), while the open method was used in 19 (3.0%). Data regarding patient and sinus characteristics, operative de-tails, postoperative course, complications and recurrence were recorded. Mean follow-up was 73.5 months. Results: 571 patients were male (90.1%) and 63 were female (9.9%). Their ages ranged between 16 - 44 years (mean 25.7 years). The mean body mass index was 31.2 (range 23.6 - 41.9), and 71.5% (453/634) were hirsute. Chronic PNS was the first presentation (primary) in 504 patients (79.5%) and recurrent in 130 (20.5%).Overall complication rate was 16.1% (102/ 634) and overall recurrence rate was 8.4% (53/634). Comparing both groups showed that they were similar regarding demographic characteristics, clinical presentation, hospital stay, healing time and time off work. Operative time was insignificantly longer with Karydakis technique (mean 43.2 versus 39.1 minutes, respectively). Complications were sig-nificantly more in patients with midline closure (21%, 78/371) as compared with Karydakis procedure (9%, 22/244) (P = 0.0001). Likewise, there was a significantly (P = 0.0001) higher rate of recurrence with midline closure (12.1%, 45/371) as opposed to Karydakis technique (2.5%, 6/244). Conclusions: 1) PNS affects mainly young male adults who are usually, obese and hirsute, 2) Karydakis technique for the management of chronic PNS, whether primary or recurrent, is a non-lengthy, efficient procedure that has less overall complications and a lower recurrence rate than conventional excision and midline closure.
Highlights
Chronic pilonidal sinus (PNS) is a common disabling disorder that affects mainly young adults [1]
There were 571 men (90.1%) & 63 women (9.9%). Their ages ranged between 16 - 44 years with a mean of 25.7 years.The mean Body mass index (BMI) of the study population was 31.2, and 72.9% (462/634) of patients were hirsute in nature
Thought to be congenital in origin, it is appreciated that hair insertion causes PNS, and prevents spontaneous recovery, delays healing, and is the main cause of recurrence [3]
Summary
Chronic pilonidal sinus (PNS) is a common disabling disorder that affects mainly young adults [1]. It has a high incidence in some countries, in the Middle East and Gulf region owing to differing hair characteristics and growth patterns [2,3,4]. Surgery should eradicate the existing sinus and the crevice in which hair tends to accumulate, and aim to establish complete and rapid primary healing and to prevent recurrence [5,6]. The ideal operation should be simple, require short hospitalization, cause minimal morbidity, and allow rapid return to work and normal activities [7]
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