The comparison between drainage, delayed excision and primary closure with excision and secondary healing in management of pilonidal abscess

Abstract

Objective There are numerous methods of treatment for pilonidal abscess; however the best method in acute pilonidal abscess has remained controversial. The present study was designed to compare drainage, delayed excision and primary closure with excision and secondary healing in this relation. Methods In a randomized clinical trial study among 102 patients with definite diagnosis of pilonidal abscess referred to the Colorectal Clinic of Nemazee Hospital, 80 patients who fulfilled the criteria of entering the study were selected and divided into two groups of A and B. The exclusion criteria were any history of pilonidal abscess operation, diabetes mellitus, renal failure and immunosuppression. In group A, drainage and delayed excision (3 weeks afterwards) and primary closure were performed while in group B, excision and secondary healing was performed. Patients were followed twice a week for 1 month and then 2, 6 and 12 months after the operation. The two methods were compared in terms of time period for wound healing, postoperative complications and any sign of recurrence. Results Symptoms were relieved in all patients. All patients returned to work 7–9 days after the operation. After 6 months, there was no signs of recurrence in both groups. After 12 months in group B, the same results were observed as previous months while in group A, 14% developed recurrence of pilonidal abscess. Wound infection was noticed in 5.6% of patients in group A and 2.5% in group B and the difference was not significant ( p > 0.05). All patients in group B developed wound healing during 6 weeks except two of them who had a delay in this finding up to 8 weeks. Conclusion The results of drainage and primary wound closure were comparable to the excision and secondary wound healing except in the rate of recurrence which was more frequent in the primary wound closure. As a result, in spite of much property and comfort of primary wound closure, this method would not be recommended for all cases with acute pilonidal abscess.