Pilonidal sinus: a comparative study of treatment methods

INTRODUCTION Pilonidal disease is a very common anorectal problem without a clinical consensus on its optimal management. OBJECTIVE To compare the methods used by our clinic and determine the outcomes in relation to healing, hospitalization time and recurrence. MATERIALS AND METHODS We have studied all the cases of patients with pilonidal sinus that were treated surgically in our clinic from January 1, 1997 to December 31, 1999. RESULTS A total of 111 patients were treated of whom 92 (82,8%) were men and 19 (17,2%) were women. Ages ranged from 16 to 65 years with an average age of about 25,1 years. Of the 111 patients, 63 were treated with marsupializationand the remaining 48 were treated by excision (29 with open excision and 19 with the primary suture technique). One hundred and two (91,9%) patients were discharged from the hospital after the surgical procedure, while the remaining 9 patients were hospitalized for 24 hours. The healing time for marsupialization was 27,3 days, the primary suture technique was 11,7 days and the open excision method took 46,4 days. Recurrence was observed in 16 patients (14,4%). Recurrence appeared in 4 (6,35%) of the 63 patients subjected to marsupialization, 1 of the 29 patients subjected to open incision, and 11 (57,8%) of the 19 patients subjected to primary closure. CONCLUSION In the absence of inflammation and/or recurrence, marsupialization is the surgical method of choice as it has a low percentage of recurrence and an acceptably short healing period.In apparently large, inflamed and recurrent situations, open excision is preferred.