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Is wide local excision for pilonidal disease still justified?
Talar Tejirian1, Jenny J Lee, Maher A Abbas
1Department of Surgery, Section of Colon and Rectal Surgery, Kaiser Permanente, Los Angeles, California 90027, USA.
The American Surgeon
|November 7, 2007
Summary
For chronic pilonidal disease, unroofing and marsupialization (UM) offers faster healing and fewer complications than wide local excision (WLE). UM is recommended as the primary surgical intervention for most patients.
Area of Science:
- Surgical outcomes
- Proctology
- Minimally invasive surgery
Background:
- Chronic pilonidal disease management remains debated.
- Wide local excision (WLE) and unroofing and marsupialization (UM) are primary surgical options.
Purpose of the Study:
- To compare the outcomes of WLE versus UM for chronic pilonidal disease.
- To evaluate healing time, complications, and reoperation rates.
Main Methods:
- Retrospective review of 68 patients over 5 years.
- Comparison of WLE (26 patients) and UM (42 patients).
- Outcomes assessed included time to healing and complication rates.
Main Results:
- UM demonstrated significantly faster healing (6 weeks) compared to WLE (21 weeks).
- WLE had significantly higher postoperative complication and reoperation rates (35%) than UM (2%).
- Reoperation was required for 9 WLE patients versus 1 UM patient.
Conclusions:
- Wide local excision for pilonidal disease is associated with high complication and reoperation rates.
- Unroofing and marsupialization should be considered the preferred initial surgical treatment for most patients.
