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Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus

A prospective, randomized clinical trial with a complete two-year follow-up

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background and aims

The best surgical technique for treating pilonidal sinus disease is controversial. The aim of this study is to compare the modified lay-open technique with primary closure following excision with respect to operating time, healing time, time before return to work, morbidity rate, and recurrence rate.

Patients and methods

After a pre-study power analysis, 142 patients with chronic sacrococcygeal pilonidal sinus were prospectively and randomly allocated, either to the modified lay-open group (Group A, n=73) or the primary closure group (Group B, n=69). In the former, incision, curettage, partial lateral wall excision, and marsupialization were performed. Single doses of cefazoline (1 g) and metronidazole (500 mg) were given intravenously 15 min before surgery to all patients.

Results

There were no differences with respect to gender, age, body mass index, and mean operating time between the groups. In Group A, healing failure and early bridging occurred in one patient each. In Group B, wound infection occurred in four patients, wound breakdown in three, one healing failure and hematoma in one patient each. Morbidity and recurrence rates were significantly lower in Group A (2.7 vs. 13%, P=0.028 and 1.4 vs. 17.4%, P<0.001 respectively). The median time before return to work in Group A was significantly shorter than in Group B (3 [range 2–8] vs. 21 [range 14–63] days, P<0.001). The median healing time in Group A was significantly longer than in Group B (7 [range 3–16] weeks vs. 2 [range 2–9] weeks; P<0.001).

Conclusion

The results of the present study suggest that modified lay-open is superior to excision with primary closure for the surgical treatment of chronic sacrococcygeal pilonidal sinus with regard to morbidity and recurrence rates, and time before return to work, although healing time is longer.

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References

  1. Kitchen PR (1982) Pilonidal sinus: excision and primary closure with a lateralised wound—the Karydakis operation. Aust NZ J Surg 52:302–305

    Google Scholar 

  2. Karydakis GE (1992) Easy and successful treatment of pilonidal sinus after explanation of its causative processes. Aust NZ J Surg 62:385–389

    Google Scholar 

  3. Surrell JA (1994) Pilonidal disease. Surg Clin North Am 74:1309–1315

    Google Scholar 

  4. Schoeller T, Wechselberger G, Otto A, Papp C (1997) Pilonidal sinus: experience with the Karydakis flap. Br J Surg 84:890–891

    Google Scholar 

  5. Sondenaa K, Andersen E, Nesvik I, Soreide JA (1995) Patient characteristics and symptoms in chronic pilonidal sinus disease. Int J Colorectal Dis 10:39–42

    Article  Google Scholar 

  6. Akinci F, Coskun A, Uzunkoy A (2000) Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Colon Rectum 43:701–706

    Google Scholar 

  7. Isbister WH, Prasad J (1995) Pilonidal disease. Aust NZ J Surg 65:561–563

    Google Scholar 

  8. Klin B, Heller ON, Kaplan I (1990) The use of the CO2 laser in pilonidal sinus disease: preliminary results of an ambulatory prospective study. J Clin Laser Med Surg 8:31–37

    Google Scholar 

  9. Cubukcu A, Gonullu NN, Paksoy M, Alponat A, Kuru M, Ozbay O (2000) The role of obesity on the recurrence of pilonidal sinus disease in patients, who were treated by excision and Limberg flap transposition. Int J Colorectal Dis 15:173–175

    Google Scholar 

  10. Akinci OF, Bozer M, Uzunkoy A, Duzgun SA, Coskun A (1999) Incidence and aetiological factors in pilonidal sinus among Turkish soldiers. Eur J Surg 165:339–342

    Article  Google Scholar 

  11. Sondenaa K, Nesvik I, Andersen E, Natas O, Soreide JA (1995) Bacteriology and complications of chronic pilonidal sinus treated with excision and primary suture. Int J Colorectal Dis 10:161–166

    Article  Google Scholar 

  12. Chaudhuri A, Bekdash BA (2002) Single-dose metronidazole versus 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective randomised controlled double-blinded study. Int J Colorectal Dis 17:355–358

    Google Scholar 

  13. Miocinovic M, Horzic M, Bunoza D (2001) The prevalence of anaerobic infection in pilonidal sinus of the sacrococcygeal region and its effect on the complications. Acta Med Croat 55:87–90

    Google Scholar 

  14. Al-Hassan HK, Francis IM, Neglen P (1990) Primary closure or secondary granulation after excision of pilonidal sinus? Acta Chir Scand 156:695–699

    Google Scholar 

  15. Perruchoud C, Vuilleumier H, Givel JC (2002) Pilonidal sinus: how to choose between excision and open granulation versus excision and primary closure? Study of a series of 141 patients operated on from 1991 to 1995. Swiss Surg 8:255–258

    Google Scholar 

  16. Fuzun M, Bakir H, Soylu M, Tansug T, Kaymak E, Harmancioglu O (1994) Which technique for treatment of pilonidal sinus—open or closed? Dis Colon Rectum 37:1148–1150

    Google Scholar 

  17. Sondenaa K, Andersen E, Soreide JA (1995) Morbidity and short term results in a randomised trial of open compared with closed treatment of chronic pilonidal sinus. Eur J Surg 158:351–355

    Google Scholar 

  18. Khaira HS, Brown JH (1995) Excision and primary suture of pilonidal sinus. Ann R Coll Surg Engl 77:242–244

    Google Scholar 

  19. Serour F, Somekh E, Krutman B, Gorenstein A (2002) Excision with primary closure and suction drainage for pilonidal sinus in adolescent patients. Pediatr Surg Int 18:159–161

    Google Scholar 

  20. Tritapepe R, Di Padova C (2002) Excision and primary closure of pilonidal sinus using a drain for antiseptic flushing. Am J Surg 183:209–211

    Google Scholar 

  21. Erdem E, Sungurtekin U, Nessar M (1998) Are postoperative drains necessary with Limberg flap for treatment of pilonidal sinus? Dis Colon Rectum 41:1427–1431

    Google Scholar 

  22. Williams RS (1990) A simple technique for successful primary closure after excision of pilonidal sinus disease. Ann R Coll Surg Engl 72:313–314

    Google Scholar 

  23. Kitchen PR (1996) Pilonidal sinus: experience with the Karydakis flap. Br J Surg 83:1452–1455

    Google Scholar 

  24. Lundhus E, Gottrup F (1993) Outcome at three to five years of primary closure of perianal and pilonidal abscess. A randomised, double-blind clinical trial with a complete three-year follow-up of one compared with four days’ treatment with ampicillin and metronidazole. Eur J Surg 159:555–558

    Google Scholar 

  25. Al-Jaberi TM (2001) Excision and simple primary closure of chronic pilonidal sinus. Eur J Surg 167:133–135

    Article  CAS  PubMed  Google Scholar 

  26. Kronborg O, Christensen K, Zimmermann-Nielsen C (1985) Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72:303–304

    Google Scholar 

  27. Stephens FO, Stephens RB (1995) Pilonidal sinus: management objectives. Aust NZ J Surg 65:558–560

    Google Scholar 

  28. Corman ML (1984) Colon and rectal surgery. Lippincott, Philadelphia

    Google Scholar 

  29. Chassin JL (1994) Operative strategy in general surgery, 2nd edn. Springer, Berlin Heidelberg New York

    Google Scholar 

  30. Solla JA, Rothenberger DA (1990) Chronic pilonidal disease. An assessment of 150 cases. Dis Colon Rectum 33:758–761

    Google Scholar 

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Acknowledgements

The authors thank Hakan Özgen for preparing the illustrations and Dr. İlgin Özden for the editing of this article.

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Authors and Affiliations

  1. Unit of Surgery, Marmara University Institute of Gastroenterology, Basibuyuk, Maltepe, PK: 53, 81532, Istanbul, Turkey

    Rasim Gencosmanoglu

  2. Department of General Surgery, Marmara University School of Medicine, Istanbul, Turkey

    Resit Inceoglu

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  1. Rasim Gencosmanoglu
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  2. Resit Inceoglu
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Correspondence to Rasim Gencosmanoglu.

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Gencosmanoglu, R., Inceoglu, R. Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus. Int J Colorectal Dis 20, 415–422 (2005). https://doi.org/10.1007/s00384-004-0710-5

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