Laying Open and Curettage under Local Anesthesia to Treat Pilonidal Sinus: Long-Term Follow-Up in 111 Consecutively Operated Patients

Abstract

(1) Background: Several techniques for the treatment of pilonidal sinus disease (PSD) are in vogue, though none have emerged as the gold standard. Laying open (deroofing) and curettage under local anesthesia is one of the most straightforward procedures to treat PSD. In this study, the long-term follow-up in a large series was analyzed. (2) Methods: The laying open approach was performed for all types of consecutive PSD patients—simple, complicated, and abscess. The primary outcome parameter of the study was the healing rate. The secondary outcome parameters were operating time, hospital stay, time to resumption of normal work, and healing time. (3) Results: 111 (M/F–92/19, mean age-22.9 ± 5.7 years) consecutive patients were operated on and followed for 38 months (6–111 months). Of these, 24 had pilonidal abscesses, 87 had chronic pilonidal disease, while 22 had recurrent disease. Operating time and hospital stay were 24 ± 7 min and 66 ± 23 min, respectively. On average, patients could resume normal work in 3.6 ± 2.9 days and the healing time was 43.8 ± 7.4 days. Three patients were lost to follow-up. Complete resolution of the disease occurred in 104/108 (96.3%) patients, while 4 (3.7%) had a recurrence. One recurrence was due to a missed tract, while three recurrences presented after complete healing had occurred. Two patients with recurrence were operated on again with the same procedure, and both healed completely. Thus, the overall success rate of this procedure was 98.1% (106/108) with a recurrence rate after first surgery of 3.7% over a median follow-up of 38 months. (4) Conclusions: Pilonidal disease managed by laying open (deroofing) with curettage under local anesthesia is associated with a high cure rate. This procedure is effective in treating all kinds of pilonidal disease (simple, complicated, and abscess).

Pilonidal Sinus Is Like an Ordinary Abscess and Should Be Treated Like One

“…4,5 A recent study demonstrated a long-term (median follow-up of 38 months) success rate of 98% with the LOCULA procedure in a cohort of 108 patients consisting of both simple and complicated PSD (pilonidal abscess and recurrent PSD). 2…”

“…The wound is packed lightly with gauze. 2 After the procedure, the patient is allowed to walk to the recovery room and is instructed to lie in a supine position putting full bodyweight on the operated site for half an hour. After this, if the wound-site dressing does not show any active bleeding, the patient is discharged from the hospital with instructions to resume his/her daily routine.…”

“…2 The LOCULA procedure is performed under local anesthesia in a day-care setting. 2 The patient is placed in the prone position, and an adhesive tape is used to spread the buttocks. Twenty ml of 2% lignocaine with adrenaline (1:100,000) is used for local anesthesia.…”

“…The sinus opening is probed gently to gauge the direction and length of the tract. 2 A curved artery forceps is inserted in the sinus tract, and the overlying tissue is incised with electrocautery. All the branches are identified and are laid open in continuity.…”

“…PSD is a superficial disease, and the pathology (abscess/ sinus) is just below the skin. 2 The 2 points which differentiate PSD from any other ordinary subcutaneous abscess are its peculiar location in the intergluteal cleft and penetration of hairs inside the sinus tract. Both these points complement each other and facilitate the formation of PSD.…”