Our experience of simple technique for successful primary closure after excision of pilonidal sinus disease

Abstract

Background: Chronic pilonidal disease is a debilitating condition that typically affects young adults. Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease in terms of minimizing disease recurrence and patient discomfort. Primary closure after excision of post anal pilonidal sinus disease frequently has been complicated by wound breakdowns. Healing by second intention takes many weeks and requires supervised wound care. A simple technique has been developed which has resulted in primary healing in 41 of 45 patients treated in a 5-year period. Methods: During the period November 2010 to December 2014, 45 patients underwent excision and primary closure of their pilonidal sinus by method as described. Results: In all, 4 (9.5%) developed a recurrence of their pilonidal sinus; one at a different site and one could have been predicted from the histology which showed incomplete excision. If these two patients are excluded, the recurrence rate falls to 4.7 %.). In our series, most patients were male (male: female ratio 3:1), the mean age was 27.7 years, and these data compare with that in other series. The main aim of primary closure is rapid healing and this is achieved by the prevention of sepsis and hematoma formation; the causes of wound breakdown. The use of high vacuum suction drainage has been shown to be effective in preventing these complications but the patient is confined to bed for2 days and to hospital for at least 4 days. We have found that meticulous attention to haemostasis and the use of a 'fat stitch' to minimize the subcutaneous cavity allows for minimal in hospital stay with similar results (early complication rate of 8.8% in our series compared with 6.4% reported by Williams. Conclusions: We therefore advocate this method of treating pilonidal sinus which has a short hospital stay, minimal morbidity, rapid healing, short time off work, and low recurrence.