Abstract
Purpose
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 primary closure and excision with flap reconstruction in the surgical treatment of sacrococcygeal pilonidal disease.
Methods
From January 2003 to January 2006, 60 consecutive patients with primary pilonidal sinus disease received surgical treatment in the form of either excision and primary closure (group I, n = 20 patients) or excision and flap reconstruction (group II, n = 40 patients; modified Limberg flap n = 20, classic Limberg flap n = 10 and adipo-fasciocutaneous flap n = 10). Times for complete healing and return to work were recorded. To evaluate patient comfort, all patients were asked to complete a questionnaire including visual analog scale, time to sitting on toilet without pain, and time to walking without pain 3 months after surgery.
Results
Mean follow-up was 21 months. A significant difference was observed between the two groups in terms of length of hospital stay (P < 0.003), time to complete healing (P < 0.001), time off work (P < 0.001), wound infection (P < 0.01), recurrence rates (P < 0.01), times to sitting on toilet without pain (P < 0.002), and walking without pain (P < 0.001). The mean (standard deviation) postoperative visual analog scale scores were 6.1 (1.2) in the primary closure group vs. 7.4 (1.3) in the flaps groups (P < 0.001). In the modified Limberg flap, no wound infection, wound breakdown, or recurrence of the disease occurred.
Conclusions
Flap reconstructions were superior to primary closure after excision of pilonidal sinus and that modified Limberg flap was superior with regard to wound infection and recurrence.
Similar content being viewed by others
References
Schoeller T, Wechselberger G, Otto A, et al. Definite surgical treatment of complicated recurrent pilonidal disease with a modified fasciocutaneous V-Y advancement flap. Surgery 1997;121:258–63.
Bascom J. Pilonidal disease: origin from follicles of hairs and results of follicle removal as treatment. Surgery 1980;87:567–72.
Arumugam PJ, Chandrasekaran TV, Morgan AR, et al. The rhomboid flap for pilonidal disease. Colorectal Dis 2003;5:218–21.
Yilmaz S, Kirimlioglu V, Katz D. Role of simple V-Y advancement flap in the treatment of complicated pilonidal sinus. Eur J Surg 2000;166:269–72.
Cubukcu A, Gonullu NN, Paksoy M, et al. 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 2000;15:173–5.
Quinodoz PD, Chilcott M, Grolleau JL, et al. Surgical treatment of sacrococcygeal pilonidal sinus disease by excision and skin flaps: the Toulouse experience. Eur J Surg 1999;165:1061–5.
Hurst DW. The evolution of management of pilonidal sinus disease. Can J Surg 1984;27:603–5.
Sondenaa K, Andersen E, Soreide JA. Morbidity and short term results in a randomised trial of open compared with closed treatment of chronic pilonidal sinus. Eur J Surg 1992;158:351–5.
Zimmerman CE. Outpatient excision and primary closure of pilonidal cysts and sinuses. Long-term follow-up. Am J Surg 1984;148:658–9.
al-Hassan HK, Francis IM, Negl EN. Primary closure or secondary granulation after excision of pilonidal sinus. Acta Chir Scand 1990;156:695–9.
Khatri V, Espinosa MH, Amin AK. Management of recurrent pilonidal sinus by simple V-Y fasciocutaneous flap. Dis Colon Rectum 1994;37:1232–5.
Solla JA, Rothenberger DA. Chronic pilonidal disease: an assessment of 150 cases. Dis Colon Rectum 1990;33:758–61.
Onishi K, Maruyama Y. Sacral adipofascial turn-over flap for the excisional defect of pilonidal sinus. Plast Reconstr Surg 2001;108:2006–10.
Marks J, Harding KG, Hughes LE, et al. Pilonidal sinus excision – healing by open granulation. Br J Surg 1985;72:637–40.
Miocinovic M, Horzic M, Bunoza D. The prevalence of anaerobic infection in pilonidal sinus of the sacrococcygeal region and its effect on the complications. Acta Med 2001;55:87–90.
Akinci OF, Bozer M, Uzunkoy A, et al. Incidence and etiological factors in pilonidal sinus among Turkish soldiers. Eur J Surg 1999;165:339–42.
Karydakis GE. The etiology of pilonidal sinus. Hellenic Armed Forces Med Rev 1975;7:411–6.
Corman ML. Colon and rectal surgery. 2nd ed. Philadelphia: Lippincott, 1989:297–304.
Armstrong J, Barcia P. Pilonidal sinus disease. Arch Surg 1994;129:914–8.
Koorista HP. Pilonidal sinuses. Review of literature and report of three hundred and fifty cases. Am J Surg 1942;55:3–17.
Akıncı OF, Coskun A, Uzunkoy A. Simple and effective surgical treatment of pilonidal sinus. Dis Colon Rectum 2000;43:701–2.
Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. ANZ J Surg 1992;62:385–9.
Kitchen PR. Pilonidal sinus: experience with the Karydakis flap. Br J Surg 1996;83:1452–5.
Nessar G, Kayaalp C, Seven C. Elliptical rotation flap for pilonidal sinus. Am J Surg 2004;187:300–3.
Jensen SL, Harling H. Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess. Br J Surg 1988;75:60–1.
Hodgson WJ, Greenstein RJ. A comparative study between Z-plasty and incision and drainage or excision with marsupialization for pilonidal sinuses. Surg Gynecol Obstet 1981;153:842–4.
Edwards MH. Pilonidal sinus. a 5-year appraisal of the Millar-Lord treatment. Br J Surg 1977;64:867–8.
Khaira HS, Brown JH. Excision and primary closure of pilonidal sinus. Ann R Coll Surg Engl 1995;77:242–4.
Morell V, Brian LC. Surgical treatment of pilonidal disease: comparison of three different methods in fifty-nine cases. Mil Med 1991;156:144–6.
Holm J, Hultén L. Simple primary closure for pilonidal sinus. Acta Chir Scand 1970;136:537–40.
Manterola C, Barroso M, Araya JC, et al. Pilonidal disease: 25 cases treated by the dufourmental technique. Dis Colon Rectum 1991;34:649–52.
Azab AS, Kamal MS, Saad RA, et al. Radical cure of pilonidal sinus by a transposition rhomboid flap. Br J Surg 1984;71:154–5.
Rossi P, Rusoo F, Gentileschi P, et al. The pilonidal sinus: its surgical management, our experience and a review of the literature. G Chir 1993;14:120–3.
Raghubir S, Pavithran M. Adipo-fascio-cutaneous flaps in the treatment of pilonidal sinus: experience with 50 cases. Asian J Surg 2005;28:198–201.
Abu Galala KH, Salam IM, Abu Samaan KR, et al. Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomized clinical trial. Eur J Surg 1999;165:468–72.
Eryilmaz R, Sahin M, Alimoglu O, et al. Surgical treatment of sacrococcygeal pilonidal sinus with the Limberg transposition flap. Surgery 2003;134:745–9.
Kronborg O, Christensen K, Zimmermann-Nielsen C. Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 1985;72:303–4.
Petersen S, Koch R, Stelzner S, et al. Primary closure techniques in chronic pilonidal sinus: a survey of the results of different surgical approaches. Dis Colon Rectum 2002;45:1458–67.
Urhan MK, Kücükel F, Topgül K, et al. Rhomboid excision and Limberg flap for managing pilonidal sinus. Result of 102 cases. Dis Colon Rectum 2002;45:656–9.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Mahdy, T. Surgical Treatment of the Pilonidal Disease: Primary Closure or Flap Reconstruction After Excision. Dis Colon Rectum 51, 1816–1822 (2008). https://doi.org/10.1007/s10350-008-9436-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-008-9436-8