Delayed primary closure of pilonidal sinus disease

الملخص EN

Pilonidal sinus disease is an irritating disease for young adults that carries a high patient discomfort.

All surgeons are aiming for the best surgical technique to lessen discomfort, and long postoperative morbidity, such as work incapability, and difficulty in sitting on toilet which occurs with lay open technique. Study design prospective non randomized single institution study. We aimed to perform a delayed primary closure of the open wound after 7 days post operatively to enhance a healing process and improving the quality of life. Twenty consecutive patients complaining of primary pilonidal sinus disease presented to the Department of surgery, Medical Research Institute from Jan 2004 till the end of Jan 2005.

All patients were submitted to wide excision of the pilonidal sinus followed by packing of the wound for 48 hours.

Then daily dressing of the wound was achieved.

After the wound became clean with creeping of healthy granulation tissue, after one week, closure of the wound was done.

The two procedures were done under low dose subarachnoid local anesthetic (bupivacaine combined with fentanyl) for ambulatory surgery.

All patients were followed up every 2 weeks for a period of 6 months. 20 patients with pilonidal sinus disease, three had pilonidal abscess.

16 were males and 4 were females.

Mean age was 22.95 years.

All patients underwent removal of the pack after 2 days.

In 18 patients (90%) wounds clean while in the remaining 2 cases (10%) infection developed; which led to delaying closure of the wound.

One week more till subsiding of the infection, the stitches were removed after 2 weeks after closure.

In 95% complete healing of the wound occurred, while in 5% delayed healing of the epidermis which does not bothers the patient or affect quality of life.

Mean healing time was 14.35 days.

Outcome of the operation: 90% symptoms free, 10% had tender wounds, 10% developed infection and 5% had delayed healing. This procedure resulted in a decreased complication rate, shorter convalescence and minimal post-operative discomfort.

Altogether improve patient's quality of life.

Prospective randomized trials are warranted and should be done on a large number of patients.