Comparison of Common Surgical Procedures in Non‐complicated Pilonidal Sinus Disease, a 7‐Year Follow‐Up Trial

Abstract

Background Pilonidal disease is a common problem in primary health care which may require immediate surgical referral. Although various management options have been proposed, so far there is no gold standard treatment. The aim of the present study was to determine which of the following techniques was superior as regards postoperative complications and recurrence, midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. Methods A randomized clinical trial was conducted in the Department of General Surgery. Patients with noncomplicated pilonidal sinus were enrolled in the study from April 2009 to January 2012. All patients were randomized the day of surgery at the coordinating center by means of a computer program. Patients were randomized to receive midline unshifted adipofascial turn-over flap, midline shifted adipofascial turn-over flap or Karydakis flap. All procedures were performed under local anesthesia and patients were discharged 6 h after surgery. Demographic characteristics, skin color, body hair type, family history, preoperative complaints and duration of symptoms, cyst size, intraoperative iatrogenic cyst rupture, the presence of a tuft of hairs in the cyst, surgical techniques, duration of drainage, length of hospital stay, postoperative complications and recurrence were evaluated. Results One hundred and ninety-two patients with non-complicated pilonidal sinus were enrolled. Seventy-two patients were randomized to midline unshifted adipofascial turn-over flap, 67 patients to midline shifted adipofascial turn-over flap and 53 patients to Karydakis flap. The mean age was 25.66 ± 7.67 years. At 76-month follow-up, the overall complications and recurrence rates were not significantly different between groups (p [ 0.05). Conclusion In cases of non-complicated pilonidal sinus, we recommend surgical management using local anesthesia, outpatient surgery and the surgical approach with which the surgeon is most familiar.

Primary Transverse Closure Compared to Open Wound Treatment for Primary Pilonidal Sinus Disease in Children

“…While there was no significant difference in the volume of excised tissue between the two groups, the extent of excised tissue correlated with total LOS, which was longer in the OW group than the PC group. Caliskan et al reported the amount of excised tissue in terms of median diameter of the pilonidal cyst (20.1 mm; SD: 8.0 mm) rather than the volume, which makes comparison to our findings impossible [ 11 ].…”

“…In an RCT with a 7-year follow-up comparing midline, unshifted adipofascial turnover flap, off-midline shifted adipofascial turnover flap (inverse “D”-shaped flap), and Karydakis flap, Caliskan et al detected no significant differences between groups with respect to PSD recurrence and postoperative complications [ 11 ].…”

“…To prevent chronic or acute infections, surgical excision of the sinus and its fistulas represent the most common intervention [ 1 , 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Nevertheless, no gold standard for the treatment for PSD has emerged so far [ 1 , 2 , 18 , 19 ].…”

“…The cohort of patients undergoing primary wound closure should be subdivided into patients treated by midline or off-midline suture techniques [ 4 , 10 , 11 , 14 ]. Although midline closure results in a shorter healing time than open wound methods, this approach is associated with a higher recurrence rate [ 4 , 9 , 11 , 14 , 20 ]. Several off-midline suture techniques and reconstructive operations to correct the deep and hairy natal cleft have been published [ 1 , 10 , 11 , 17 , 18 ].…”

Excision and suture in the midline versus Karydakis flap surgery for pilonidal sinus: randomized clinical trial

“…Several surgical techniques are used to treat pilonidal sinus disease, but there is a lack of consensus regarding best surgical practice 4 , 5 . Meta-analyses indicate advantages for flap techniques 6–8 such as the Karydakis flap procedure, which is an advancement flap known to be one of the simplest off-midline procedures 9 .…”