Pilonidal disease simple pathogenesis but complex management

Abstract

Design: retrospective study Patients & Methods: the study was conducted on 75 patients suffering PND with a male to female ratio 59 to 16 done between May 2004 to June 2007 with a follow up range 8-13 and a median of 10.7 months. Sixty four patients had sacrococcygeal disease, 9 patients had umbilical disease, and 1 patient had suprapubic while 1 patient had axillary disease. For sacrococcygeal disease Limberg operation was done in 26.5% (n=17), abscess drainage and curettage in 31.2% (n=20), Bascom operation in 23% (n=15) while conservative treatment in 31.2% (n=20).For umbilical disease, omphalectomy was done in all cases (n=9). Conservative treatment was done for suprapubic disease while excision followed by primary closure was done in axillary disease (n=1) after failure of conservation. Aim: to evaluate different modalities in treating pilonidal disease (PND) Results: For sacrococcygeal disease, patients who received Limberg procedure (n=17) showed complete resolution in 88.2% (n=15) with recurrence rate 11.8% (n=2). Those who received Bascom operation showed complete resolution after all procedures with no recurrence during the follow up period. Patients who received conservative treatment (n=20) showed a success rate of 70% (n=14) with recurrence rate of 30% (n=6) who received Bascom procedure later for their recurrence. For umbilical, suprapubic and axillary disease; omphalectomy, conservative treatment and excision with primary closure were used respectively with no complications encountered. Conclusion: For sacrococcygeal disease, Bascom operation was found to be superior over other modalities with respect to smooth postoperative period and early healing while in umbilical disease conservation shows higher success rate.