Introduction: The management of chronic pilonidal disease is variable and
controversial. Many procedures have been described but none of them is
considered ideal. Many surgeons treat pilonidal sinus by wide excision down
to the sacral fascia, leaving a lay open or a primary sutured midline wound.
Other surgeons, while still committed to the same wide excisions, use more
sophisticated techniques such as various types of skin flaps.
Objective: How to excise PNS minimally under local anesthesia and the
evaluation of subsequent effects on wound closure and healing process.
Patient and methods: This prospective study was carried out in 30
consecutive patients with primary non recurrent sacro-coccygeal PNS. All
patients treated surgically with minimal excision and primary closure under
local anesthesia. Patients were followed up for 6 to 36 months
postoperatively. Parameters include wound seroma, infection or disruption.
Also, pain, mobilization, time off-work and recurrence.
Results: The mean operative time is 38 minutes (range 25 – 47 min). The
hospital stay ranged from 2 to 4 hours. Healing time was (14-20 days). Three
cases (10%) presented with wound seroma. One patient (3.3%) presented by
wound infection without disruption. One patient (3.3%) presented by
significant wound infection and wound disruption; this patient presented by
recurrence after 6 months and this condition is treated by wide excision and
rhomboid flap reconstruction.
Conclusion: Minimal excision and primary closure for uncomplicated cases
of pilonidal sinus under local anesthesia is a safe, easy operative procedure.
It is found better in terms of less operative time, short hospital stay, less
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postoperative time off work, less healing time, low complication rates with
low chances of recurrence. |
