Bacteriology and complications of chronic pilonidal sinus treated with excision and primary suture

Abstract

Two prospective studies were undertaken to examine the role of bacteria in the outcome after excision and primary suture for chronic pilonidal sinus disease. In the first study 52 consecutive patients were given cloxacillin as prophylaxis. In a second randomised study 51 patients were given 2 g cefoxitin intravenously (n = 25) or no prophylaxis (n = 26). From 49 out of 98 patients (50%) no microorganisms were isolated from sinuses preoperatively. Wound complications were observed postoperatively in 61% of the patients (63/103). A postoperative bacteriology sample was positive in 47 of 49 samples (96%). Preoperative presence of bacteria was not significantly associated with wound complications. Anaerobe isolates were present in 40% of patients preoperatively whereas aerobes were cultured in 43% postoperatively. After an observation period of 30-42 months, recurrences were 13% among the patients (7/52) who had been given cloxacillin. No recurrences were seen in the last study after an observation period of 18-30 months, for an overall 7% in both studies. We conclude that preoperative bacterial isolates, usually anaerobes, in chronic pilonidal sinuses do not influence the complication rate since bacterial isolates from infected wounds are mostly aerobes.

Prospective randomized study of surgical treatment of pilonidal sinus; primary midline closure after elliptical excision versus rhomboid excision with limberg flap reconstruction versus open excision and healing by secondary intention

“…Literature has documented a recurrence rate of 0-3% for Limberg flap against a significantly high recurrence of 7-42% for primary closure. 26,[33][34][35][36][37][38] Our study also three recurrences in primary closure and nil in case of Limberg flap group and nil in 3 rd group where healing was by secondary intention. Our results also support those patients in primary closure group walked freely without significant pain after a relatively longer period than patients treated with flaps because of the tension created by the primary suture technique.…”

Elliptical Excision with Midline Primary Closure Versus Rhomboid Excision with Limberg Flap Reconstruction in Sacrococcygeal Pilonidal Disease: A Prospective, Randomized Study

“…So, looking that way one expects flap procedures to combat the disease recurrence better than excision with simple closure, keeping in view extensive dissection of the sinus tracts and the shallower cleft that flap procedures provide. Literature has documented a recurrence rate of 0-3% [2][3][4][5][6] for Limberg flap against a significantly high recurrence of 7-42% [7,8] for primary closure. Outcome of our study in terms of recurrence of the sinus is the same as reported by other studies, namely, three recurrences for the primary closure group against zero recurrence of the Limberg flap group.…”

Pilonidal Disease

“…Postoperatif değişen sürelerde verilen antibiyotiklerin yararı tartışmalı olmakla beraber profilaktik antibiyotiklerin yara komplikasyonlarını veya rekürensi azaltmadığı, iyileşmeyi hızlandırmadığı, genel olarak bakıldığında bu amaçlarla kullanılan antibiyotiklerin yara infeksiyon riskini azaltma konusunda yardımcı olmadığı belirlenmiştir (14) . Apse gelişen olgularda lokal anestezi ile apsenin drene edilmesi tek çözümdür.…”