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Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial
Tomas Lorant1, Ingar Ribbe, Haile Mahteme
1Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Background:
Surgical excision is the standard treatment for chronic pilonidal disease, but all excisional techniques are associated with tissue loss, risk of wound break down, and chronic healing problems.
Objective:
The aim of the study was to compare sinus excision and primary closure vs a laying open technique in a prospective randomized trial.
Design, Patients, And Interventions:
Eighty patients were randomly assigned to sinus excision and primary closure (n = 39) or laying open (n = 41). Follow-up was performed 1, 3, and 12 months after surgery.
Main Outcome Measure:
The main outcome measure was the healing rate after 1 year.
Results:
The healing rate was significantly higher after excision and closure than after laying open at 1 month (20 of 39 vs 8 of 41; P = .005) and 3 months (36 of 38 vs 28 of 39; P = .013) after surgery. At follow-up 12 months after surgery no difference was seen in healing rate between the treatment arms (33 of 37 vs 37 of 38; P = .198).
Conclusions:
This prospective randomized trial shows that sinus excision and primary closure results in faster healing than laying open does, but there is no difference in healing rate after 1 year. The laying open procedure is minimally invasive with small risks for the patient, and it might therefore be considered more frequently as the first choice of treatment (www.clinicaltrials.gov. Unique identifier: NCT00997048).
