Comparison of two Different Surgical Modalities in the treatment of Pilonidal Sinus (Primary Closure and Open Technique)

Background: Pilonidal sinus is disease of young age andits prevalence is higher in men compared to women (almost twice).It is a disease that arises from hair follicles particularly present in the natal cleft. It occurs commonly in Jeep Drivers and hence gets the name from there “Jeep Drivers Disease” and also commonly occurs in Barbers. It leads to formation of abscesses and chronic wounds with discharge and pain. Disease can have huge impact on social life and quality of life. In most cases the treatment is incision and drainage. Study design: It is a case series study. Place and duration of study: Department of General Surgery at Shaikh Zayed Hospital Lahore from January 2019 to January 2021. Aim: To compare the relative effects of open and closed surgical techniques on the recurrence rate, rate of infection and time of healing for pilonidal sinus. Methodology: Patients with pilonidal sinus disease from January 2019 to January 2021 received surgical treatment either excision followed by primary closure as in closed technique (group A) or excision followed by leaving the wound open for healing by secondary intention as in open technique (group B). Surgical management is widely based upon two techniques open and closed. In open technique wound is left open and heals by secondary intention while in closed technique it is closed primarily and heals by primary intention. The better choice between these two techniques is still a topic of debate. Results: The most common age group for pilonidal sinus was between 16-25 years of age. The mean age came out to be 26.7 years. The mean healing time was 15 days in group A and 42 days in group B. The duration of hospital stay ranged between 2-8 days for group A and 5-16 days for group B. Early postoperative complications seen was infection in 1 patient (7.69%) in group A and 5 patients (35.71%) in group B and these cases were managed conservatively.1 (7.69%) case of aseptic gaping of wound after stitch removal was seen in group A and was managed with closed technique. Recurrences reported in group A was 1 case (7.69%) at 6 months and was surgically managed by open technique. There were a total of 4 (28.57%) recurrences which were left open to heal by granulation. Conclusion: It is concluded that better management option for pilonidal sinus disease is primary closure of defect. So it is suggested that management of pilonidal sinus disease should be individualized but preference must be given to closure of wound after excision. Keywords: Pilonidal sinus, Primary Closure, Open Technique.

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PILONIDAL SINUS DISEASE: COMPARISON OF EXCISION AND PRIMARY CLOSURE VERSES EXCISION AND HEALING BY SECONDARY INTENTION

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2012.2.1.134-137 ◽

1969 ◽

Vol 2 (1) ◽

pp. 134-137

Author(s):

Mohammad Hussain ◽

Manzoor Ali ◽

S.M.Naeem ◽

Nisar Ali ◽

Muhammad Ismail

Keyword(s):

Local Excision ◽

Pilonidal Sinus ◽

Wide Local Excision ◽

Primary Closure ◽

Health Concern ◽

Pilonidal Sinus Disease ◽

Sinus Disease ◽

Secondary Intention ◽

Group A ◽

Group B

Introduction: Sacrococcygeal pilonidal disease is a serious health concern because of its associatedcomplications and recurrence. Pilonidal sinus disease is presented with symptoms ranging fromasymptomatic pits to painful draining lesions that are predominantly located in the sacrococcygeal region. Itis characterized by multiple subcutaneous sinuses, containing hairs. The exact etiology of the disease is notknown. Various treatment options are available. The choice of a particular surgical approach depends on thesurgeon's familiarity with the procedure and perceived results. The present study was aimed to compare twotreatment regimens i.e.excision and primary closure verses excision and healing by secondary intention.Patients and methods: The study was conducted in the department of surgery, Saidu Teaching HospitalSaidu Sharif Swat. Forty nine (49) human subjects with informed consent were included in the study.Patients were divided in two groups, depending on their preference and acceptance of the procedure.Patients in group A under went excision of the tract with primary closure of the defect by primary simpleclosure, Rhomboid Limberg flap or by Karydakis procedure. Patients in group B were those in whom sinustracts were excised and wound was left open for healing by secondary intention.Results: Out of the total 49 patients 3 (6.122%) were female. Mean age was 26 years (range 18-40years).Group A comprised of 24 patients in whom wide local excision was performed and wound was closedprimarily while Group B comprised of 25 patients who underwent wide local excision and wound was leftopen for healing by secondary intention. Mean hospital stay of patients in group B was significantly longerthan group A (p=0.002). The mean time for complete healing of the wound after primary closure wasmarkedly shorter.mConclusion: Primary closure of the wound after excision of the sinus tract is preferable over simple excisionand healing by secondary intention.Key words; Pilonidal sinus, primary closure, simple excision.

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Compare outcome of simple excision with primary closure vs rhomboid excision with limberg flap for pilonidal sinus

10.53350/pjmhs2115112920 ◽

2021 ◽

pp. 2920-2922

Author(s):

M. Kaleem ◽

F. Mubarik ◽

M. U. Afzal ◽

A. Zahid ◽

W. I. Andrabi ◽

...

Keyword(s):

Pilonidal Sinus ◽

Primary Closure ◽

Advancement Flap ◽

Pilonidal Sinus Disease ◽

P Value ◽

Limberg Flap ◽

Simple Excision ◽

Group A ◽

Group B ◽

Rhomboid Excision

Background: Sacrococcygeal pilonidal sinus is a common condition usually affecting young-to-middle-aged men. For managing sacrococcygeal pilonidal illness, a variety of lateralizing surgical flap procedures based on this principle have been published, including the Karydakis flap, Limberg flap, modified Limberg flap, Z-plasty, and Y-V advancement flap. Aim: To compare the outcome of simple excision with primary closure versus rhomboid excision with limberg flap for sacrococcygeal pilonidal sinus. Methodology: Randomized control study conducted in Surgery Department, Ghurki Trust Hospital, Lahore. 90 patients fulfilling the inclusion criteria were selected from wards and were randomly divided in two equal groups. In group A, patients underwent rhomboid excision with limberg flap. In group B, patients underwent simple excision with primary closure. The operation was performed under spinal anesthesia. After surgery, patients were evaluated every 24 hours if they are able to move on their own then they were discharged and hospital stay was noted. Then after 10 days, patients will be called in OPD for assessment of wound healing. If wound did heal and patient complained of pain (VAS>4) and cannot sit and have fever (temp>100oF) Results: The average age in group A was 44.37±15.42 years while that in group B was 45.24±14.50 years. In group A there were 23(51.1%) males and 22 (48.9%) females whereas in group B there were 25(55.6%) males and 20(44.4%) females. There was difference significant in the mean stay in hospital in both groups (p-value=0.002). Conclusion: The conclusion of the study, that primary sacrococcygeal pilonidal sinus disease and rhomboid excision with Limberg's flap is an effective treatment. Keywords: Simple Excision with Primary Closure, Rhomboid Excision, Limberg Flap, Sacrococcygeal Pilonidal Sinus

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Limberg flap versus primary closure in the treatment of pilonidal sinus: a randomised clinical study

International Surgery Journal ◽

10.18203/2349-2902.isj20213134 ◽

2021 ◽

Vol 8 (8) ◽

pp. 2388

Author(s):

Devaprashanth M. ◽

Srinivas N. M. ◽

Akhihlandeshwari N.

Keyword(s):

Clinical Study ◽

Pilonidal Sinus ◽

Primary Closure ◽

Wound Dehiscence ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Randomized Clinical Study ◽

Routine Work ◽

Group A ◽

Group B

Background: Pilonidal sinus is a chronic disease usually involving the sacrococcygeal area. Various treatment modalities exist, yet few comparison studies exist to compare the efficacy of one modality over the other. Hence this randomized clinical study was undertaken as an attempt to compare the outcomes of pilonidal sinus following Limberg flap procedure and primary closure.Methods: 60 patients undergoing surgery for pilonidal sinus disease were considered for the study. 30 patients underwent excision and primary closure and 30 patients underwent Limberg flap repair. They were followed up for 1 year. Duration of hospital stay, duration of inability to work, postoperative infection, wound dehiscence, and postoperative recurrence in a follow up period were recorded. Descriptive statistics, chi- square tests and independent t-test are the statistical tools employed.Results: Mean age was 29.83±4.99 years. Male:female ratio was 5.66:1. The mean duration of hospitalization in group A was significantly less (p<0.05) than group B. The patients in group B returned early to routine work (21.56±3.92 days) as compared to 30.5±5.92 days in group A (p<0.05). 5 of 30 patients in group A and 2 of 30 in group B developed surgical site infection. (p>0.05. 4 patients developed wound dehiscence in group A only which was found to be statistically significant.Conclusions: Limberg flap in treatment of pilonidal sinus is associated with shorter hospitalization, early return to routine work and less wound dehiscence as compared with excision and primary closure. Wound infections are comparable with both the modalities.

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Comparison of primary repair with healing by secondary intention for the treatment of pilonidal sinus, at a Tertiary Care Hospital in Karachi, Pakistan.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.08.3874 ◽

2019 ◽

Vol 26 (08) ◽

pp. 1306-1310

Author(s):

Muhammad Ghayasuddin ◽

Fareya Usmani ◽

Amtullah Sheikh ◽

Hamid Raza

Keyword(s):

Pilonidal Sinus ◽

Primary Repair ◽

Tertiary Care ◽

Healing Time ◽

Random Allocation ◽

Care Hospital ◽

Secondary Intention ◽

Group A ◽

The Mean ◽

Group B

The aim of our study is to assess the surgical outcome of healing by primary intention and compare it with primary repair for the treatment of pilonidal sinus. Study Design: Randomized controlled trial. Setting: Tertiary Care Center in Karachi Pakistan. Period: Two years from April 2015 to April 2017. Materials and Methods: 60 patients were divided into two groups by utilizing a Random Allocation Software. All the patients involved in the study signed a duly informed consent. The inclusion criteria were patients who presented to us with a pilonidal sinus and agreed to participate in the study. All the procedures were performed by the same team of surgeons. Patient follow up was bi-weekly at the outpatient. Data were collected in a predesigned proforma with various variables such as patient demographics, clinical findings, treatment option used, postoperative results, complications (if any), healing time, length of hospital stay and time for a return to function among others. The data were analyzed using IBM SPSS version 21.0. A p value of less than 0.05 was considered to be statistically significant. Results: N= 60 patients were included in the study. There were n= 51 men (85%) and n= 9 women (15%). The mean age of patients in group A was 26.45 +/- 5.81 years and the mean age of participants in group B was 27.10 +/- 5.75 years. Symptoms lasted for 6.52 +/- 2.03 days, the most common presenting complaint was pain in 51.66% of patients followed by discharge in 40% and swelling in 33.33% respectively. The mean length of stay at the hospital for both the groups was 4.40 +/- 2.11 days (4.09 +/- 1.96 days in group A and 4.85 +/- 2.33 days in group B), mean time to return to normal functioning was 17.88 +/- 8.46 days (14.50 +/- 7.30 days in group A and 23.80 +/- 6.50 days in group B). The mean healing time postoperatively for both the groups was 39.98 +/- 24.46 days (21.90 +/- 10.15 days in group A and 67.30 +/- 9.09 days in group B. Early postoperative infection was found in n=7 (11.66%) patients, wound necrosis was found in n= 2 (3.33%) patients, and recurrence of the pilonidal sinus was found in n= 3 (5%) of the patients respectively. Conclusion: According to the results of our study primary closure technique provides better outcomes in terms of early return to functioning, shorter duration of wound healing and lower rates of wound infection as compared to excision and healing by secondary intention.

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A scoring system as a method to evaluate pilonidal sinus disease to make an easy decision for its management

Indian Journal of Plastic Surgery ◽

10.1055/s-0039-1699311 ◽

2009 ◽

Vol 42 (01) ◽

pp. 043-048 ◽

Cited By ~ 1

Author(s):

Mohamed M. S. Awad ◽

Amr Abd Elbaset ◽

Samir Ebraheem ◽

Esmael Tantawy ◽

M. Abd Elhafez ◽

...

Keyword(s):

Pilonidal Sinus ◽

Scoring System ◽

Pilonidal Sinus Disease ◽

Sinus Disease ◽

Score System ◽

Surgical Decision ◽

Clinical Presentations ◽

Group A ◽

Group B ◽

Surgical Decision Making

ABSTRACTThis study was planned to evaluate prospectively the results of 150 patients with pilonidal sinus treated surgically after planning a score system. The aim was to choose the proper technique for the proper pilonidal sinus disease. From November 2002 to December 2006, 150 patients [130 male, 20 female; average age = 22.65 ± 4.2 (range, 15-46) years] with primary or recurrent pilonidal sinus diseases, operated under spinal anaesthesia or general anaesthesia. All patients were classified into three groups A, B and C. According to the clinical presentations we had three groups of patients: Group A with a score number n = 8 to 10, Group B with a score number n = 11 to 13, and Group C had the number n = 14 to 16. The study helped us in our surgical decision making, particularly in choosing the type of surgery for a given patient by our new scoring system, with promising results and low failure rate.

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Comparative study between excision with primary closure versus Limberg flap for treatment of primary sacrococcygeal pilonidal sinus

International Surgery Journal ◽

10.18203/2349-2902.isj20174873 ◽

2017 ◽

Vol 4 (11) ◽

pp. 3581 ◽

Cited By ~ 2

Author(s):

Omar Abdelraheem ◽

Magdy Khalil

Keyword(s):

Recurrence Rate ◽

Pilonidal Sinus ◽

Primary Closure ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Significant Difference ◽

Flap Repair ◽

Group A ◽

Group B ◽

Rhomboid Excision

Background: Surgical treatment of sacrococcygeal pilonidal sinus is associated with significant recurrence rate. However; recent study suggested the use of rhomboid excision and Limberg flap repair as feasible procedure for treatment of pilonidal sinus disease. Our aim is to evaluate the role of rhomboid excision of the pilonidal sinus with Limberg flap by comparing this procedure with the traditional excision and primary closure.Methods: This prospective study included 60 patients with sacrococcygeal pilonidal sinus. The patients were randomly divided into 2 equal groups. Rhomboid excision of the sinus with limberg flap was performed in 30 patients (group A), and excision of the sinus with primary closure was done to the other 30 cases (group B). Demographic data and surgical outcome were compared between both groups.Results: Group A showed significant early retained to work and significant less postoperative pain than group B (P=0.04 and P=0.02 respectively). Incidence of wound dehiscence, postoperative hematoma and seroma was less among group A but without significant difference. The incidence of postoperative infection and recurrence rate was significantly less in group A than group B (P=0.04 and P= 0.035 respectively).Conclusions: Rhomboid excision and Limberg flap repair is an advantageous and effective modality than simple excision with primary closure in treatment of sacrococcygeal disease. In addition, it is safe and easily procedure; it may be an ideal treatment option in management of pilonidal sinus.

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Pilonidal sinus disease on the rise: a one-third incidence increase in inpatients in 13 years with substantial regional variation in Germany

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03944-4 ◽

2021 ◽

Author(s):

Christina Oetzmann von Sochaczewski ◽

Jan Gödeke

Keyword(s):

Pilonidal Sinus ◽

Regional Variation ◽

Disease Incidence ◽

Age Groups ◽

Pilonidal Sinus Disease ◽

National Guidelines ◽

Reconstructive Procedures ◽

Sinus Disease ◽

The Mean ◽

Almost All

Abstract Purpose Collective evidence from single-centre studies suggests an increasing incidence of pilonidal sinus disease in the last decades, but population-based data is scarce. Methods We analysed administrative case–based principal diagnoses of pilonidal sinus disease and its surgical therapy between 2005 and 2017 in inpatients. Changes were addressed via linear regression. Results The mean rate of inpatient episodes of pilonidal sinus disease per 100,000 men increased from 43 in 2005 to 56 in 2017. In females, the mean rate of inpatient episodes per 100,000 women rose from 14 in 2005 to 18 in 2017. In the whole population, for every case per 100,000 females, there were 3.1 cases per 100,000 males, but the numbers were highly variable between the age groups. There was considerable regional variation within Germany. Rates of inpatient episodes of pilonidal sinus disease were increasing in almost all age groups and both sexes by almost a third. Surgery was dominated by excision of pilonidal sinus without reconstructive procedures, such as flaps, whose share was around 13% of all procedures, despite recommendations of the national guidelines to prefer flap procedures. Conclusion Rates of inpatient episodes of pilonidal sinus disease in Germany rose across almost all age groups and both sexes with relevant regional variation. The underlying causative factors are unknown. Thus, patient-centred research is necessary to explore them. This should also take cases into account that are solely treated office-based in order to obtain a full-spectrum view of pilonidal sinus disease incidence rates.

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Pilonidal Sinus Disease: Risk Factors for Postoperative Complications and Recurrence

International Surgery ◽

10.9738/cc86.1 ◽

2012 ◽

Vol 97 (3) ◽

pp. 224-229 ◽

Cited By ~ 29

Author(s):

Akin Onder ◽

Sadullah Girgin ◽

Murat Kapan ◽

Mehmet Toker ◽

Zulfu Arikanoglu ◽

...

Keyword(s):

Risk Factors ◽

Postoperative Complications ◽

Pilonidal Sinus ◽

Primary Closure ◽

Disease Risk ◽

Pilonidal Sinus Disease ◽

Limberg Flap ◽

Sinus Disease ◽

Faculty Department ◽

Closure Method

Abstract The aim of this study is to analyze the risk factors for complications and recurrence in pilonidal sinus disease. The prospective study consisted of 144 patients with pilonidal sinus disease who were operated on at Dicle University Medical Faculty, Department of General Surgery, between February 2008 and December 2010. Patients receiving the Limberg flap totaled 106 (73.6%), while 38 (26.4%) had primary closure. Postoperative complications developed in 42 subjects (29.2%), and recurrence occurred in 19 (13.2%). The Limberg flap method was statistically considered as a risk factor for postoperative complications (P = 0.039). Regarding recurrence, family tendency (P = 0.011), sinus number (P = 0.005), cavity diameter (P = 0.002), and primary closure (P = 0.001) were found to be risk factors. Postoperative complication rate is higher in the Limberg flap method than primary closure method. The risk of recurrence is related to family tendency, sinus number, cavity diameter and anesthesia type and is also higher in primary closure.

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