Long-term Results of Pilonidal Sinus Disease with Modified Primary Closure: New Technique on 450 Patients

Abstract

Chronic pilonidal disease is a debilitating condition that typically affects young adults. Controversy still exists regarding the best surgical technique for the treatment of pilonidal disease in terms of minimizing disease recurrence and patient discomfort. The present study analyzes the results of excision with our modified primary closure. This retrospective study involving consecutive patients with pilonidal disease was conducted over a 6-year period. From January 2004 to January 2010, 450 consecutive patients with primary pilonidal sinus disease received this new surgical treatment. Times for complete healing and return to work, the duration of operation and of hospitalization, postoperative pain, time to first mobilization, and postoperative complications were recorded. To evaluate patient comfort, all patients were asked to complete a questionnaire including visual analog scale. The median long-term follow-up was 54 months (range, 24 to 84 months). Four hundred fifty consecutive patients (96 female, 354 male) underwent excision. The median age was 25 years (range, 17 to 43 years). The median follow-up period was 54 months (range, 24 to 84 months). Four hundred twenty completed questionnaires were returned (87% response rate). The median duration of hospital stay was eight hours (range, 7 to 10 hours) No patient reported severe postoperative pain. Primary operative success (complete wound healing without recurrence) was achieved in 98.2 per cent. Two (0.5%) patients had a recurrence. The mean time lost to work/school after modified primary closure was eight days. Excision and primary closure with this new technique is an effective treatment for chronic pilonidal disease. It is associated with low morbidity, early return to work, and excellent cosmetic result and a high degree of patient satisfaction in the long-term follow-up.

Impact of geography and surgical approach on recurrence in global pilonidal sinus disease

“…at riskRR in % (95% CI)Nr. at riskPrimary open (1243)0 (0.0–0.0)12032.5* (1.2–3.8)441*4.5* (2.5–6.6)267*NANA 35, 56, 70, 72, 80, 91, 94– 96, 99, 100, 120, 610– 613 Primary median closure (5583)3.3 (2.8–3.8)41847.6 (6.7–8.5)193910.1* (8.8–11.4)786*12.2 (10.3–14.2)382 35, 56, 91, 94– 96, 99, 100, 129, 144, 146, 161, 162, 165– 168, 171, 179, 182, 186, 197, 205, 209, 214, 215, 218– 222, 610– 621 Primary asymmetric closure (1099)0.0* (0.0–0.0)1099*0.0* (0.0–0.0)1096*0.1* (0.0–0.2)1022*3.6* (2.4–4.8)937* 100, 129, 256, 260, 622 Karydakis/Bascom (109)3.7 (0.0–7.4)109NANANANANANA 16, 622 Limberg/Dufourmentel (944)0.0* (0.0–0.0)944*0.3* (0.0–0.7)891*0.3 (0.0–0.7)618NANA 56, 100, 165, 182, 205, 328, 334, 336…”

Endoscopic pilonidal sinus treatment (EPSiT) for sacrococcygeal pilonidal sinus disease: a prospective long-term study

“…Most studies with long-term follow-ups (5-15 years) reported increased rate of recurrence in all open and closed techniques. [23][24][25] A meta-analysis of older studies found 13% recurrence at 1 year after open excisions of PS, and 15% after closed excision. 26 A recent study found high recurrence rates.…”

Out of the midline—cleft lift, advancement and rotation procedures

“…Others have commented that some patients have an issue with the cosmetic appearance after Limberg flap [66], whereas the Karydakis operation had a cosmetic satisfaction rate of 91% in another study [67]. The cleft lift was described as having an excellent cosmetic result [33], as did a modified primary closure [68]. Studies should include the cosmetic appearance as a measure of success.…”