Simple and effective surgical treatment of sacrococcygeal pilonidal disease : limited excision and primary closure

Abstract EN

The aim of this work was to assess the value of limited excision under direct vision and primary closure of the sacrococcygeal pilonidal sinus while preserving the underlying sacral fat pad and surrounding healthy tissues.

Eighty consecutive patients with clinically noninfected chronic pilonidal sinus disease who presented to the surgical clinic of one military Jordanian hospital were operated on over a three years period.

Complicated cases like pilonidal abscess and extensive gluteal involvement were excluded.

Treatment consisted of limited excision under direct vision, irrigation with Povidone-lodine and primary suturing together with prophylactic and postoperative antibiotic administration against Staphylococci and Bacteroids species.

The cases were followed up for 20 months.

Male to female ratio was 3:1.

The age range was 15-45years with a mean of 25years.

Ninety percent of cases had a history of disease of less than two years, with only 10% having previous treatment in the form of drainage of abscess.

Two patients (2.5 %) hadfailed healing and two had recurrence of the disease.

Ninety percent ofpatients had a superficial disease.

Most patients returned to work in 3-4 weeks.

Our technique of limited excision under direct vision with irrigation and primary closure offers an effective and elegant alternative to the more classic operations for sacrococcygealpilonidal sinus, as it preserves the functional anatomical mechanisms and has minimal morbidity, short hospital stay, rapid healing and low rate of recurrence.