Comparison of Drainage, Delayed Pits Excision, and Closure With Excision and Secondary Healing in Pilonidal Sinus Abscess Cases

Abstract

A pilonidal abscess is an emergency situation which requires immediate drainage and is usually seen in young men. We aimed to compare incision and draining (I&D) of acute pilonidal abscess (PSA) and healing by secondary intention with I&D and subsequent delayed pits excision and closure (PE/PC). A total of 62 patients admitted with PSA were randomized to undergo either I&D and healing by secondary intention (group 1, n ¼ 33) or I&D and PE/PC (group 2, n ¼ 29). Demographic characteristics of the patients, abscess depth and location, duration and healing times of the symptoms, time required to return to work, and ratio of chronic pilonidal sinus (PNS) development were recorded, and the two methods were compared. No statistically significant differences were found between the groups in relation to sex, age, and preoperative findings, including discharge, infection, pain, and length and depth of abscess. There was no difference in length of hospital stay between the groups, and no statistically significant difference was found between the groups in terms of complication rate (P ¼ 0.298). A statistically significant difference (P ¼ 0.033) was, however, found between the two groups in the recurrence rate of a pilonidal abscess (9.09% in group 1 versus 3.44% in group 2). A statistically significant difference was also observed between the groups in terms of development of chronic PNS (P ¼ 0.020). According to the results of our study, I&D and PE/PC should be the primary procedure used, as opposed to skin incision, curettage, and secondary healing for the treatment of PSA.Key words: Pilonidal abscess -Drainage -Excision -Incision A pilonidal sinus (PNS) is a common condition that affects young to middle-aged adult men. The pathogenesis remains uncertain, with arguments suggesting both congenital and acquired bases for the etiology of this condition.1 PNS disease is caused by the penetration of hairs into the skin of the gluteal cleft, which, due to foreign body reaction, leads to cyst and sinus formation followed by secondary infections and abscesses. 2A pilonidal abscess is one of the most common complications associated with pilonidal disease. 3,4 Pilonidal abscesses may lead to large tissue damage and sepsis unless treated. Pilonidal sinus, which is associated with abscess exacerbations, may spread to the anal canal or perianal region. 5,6 Despite the variety of surgical techniques proposed for the treatment of PSA, the ''best method'' to use is still a matter of debate.7 Conventional treatment of a pilonidal abscess is incision and simple drainage whereby large tissue damage is prevented and the patient is relieved of pain. However, chronic PNS develops in 16% to 92.5% of patients following a simple drainage. In these cases, surgical treatment is required. [8][9][10] The ideal approach for treating pilonidal disease should be simple, inflict minimal pain, have the best chance for cure and least local recurrence rate, avoid admission to the hospital, not require general anesthesia, require minimal wound care, pose mi...