Flap Closure for Gluteal Pilonidal Sinus- Is It an Economically Viable Option?

Abstract

BACKGROUNDFlap closure technique for sacrococcygeal pilonidal sinus disease has been conclusively shown to be effective in relieving recurrence rate in many studies, but it is expensive and difficult to perform. Purpose of this study is to find out if simple primary closure is effective in management as claimed by some authors and to determine which of the procedures is easier on the pocket for the patient. MATERIALS AND METHODSPatients were enrolled into either of the two groups-Group A-Simple primary closure. Group B-Flap closure and gluteal sulcus obliterative procedures based on their choice after explaining the type of procedure and the approximate cost involved in both. Parameters recorded and analysed by Pearson's Chi-square test for statistical significance. RESULTS95 patients were included for the study-42 in Group A and 53 in Group B. Male-to-female ratio of 5:2 and 11:4, respectively; average age of 25 in both the groups (range 15 to 40 years in group A, 16 to 41 in group B). There were 17 wound dehiscence, 2 seromas and 7 recurrences in group A and 16 wound dehiscence, 8 seromas and 2 recurrences in group B. The difference is the recurrence rate being statistically significant. 12 patients-8 with non-healing wounds and 4 with recurrences from group A joined group B while 9-6 with dehiscence and 3 recurrences were lost to follow up. Average wound healing time in the simple closure patients was 31 days, while in group B, it was 16.4 days. Average expenditure incurred by patients in primary closure group was Rs. 7,900 compared to Rs. 9,300 in group B, but if the additional expense due to crossing over to group B was added, average jumped up to Rs. 10,700, which was Rs. 1000 more than the flap closure patients. CONCLUSIONIn management of patients with chronic sacrococcygeal pilonidal sinus, even though the average cost of treatment by simple primary closure is less than that by flap closure technique, the significantly higher rate of recurrence and prolonged time to heal in case of wound dehiscence nullifies whatever pecuniary benefits they may have gained and hence flap closure is advisable especially in patients with recurrent disease.