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Primary closure or secondary granulation after excision of pilonidal sinus?
H K al-Hassan1, I M Francis, P Neglén
1Department of Surgery, Kuwait University.
Acta Chirurgica Scandinavica
|October 1, 1990
Summary
Excision with primary closure offers faster initial healing for chronic pilonidal disease compared to secondary granulation. While cure rates are similar, primary closure reduces healing time and sick leave.
Area of Science:
- Surgical Procedures
- Proctology
- Wound Healing
Background:
- Chronic pilonidal disease presents a significant challenge in surgical management.
- Treatment options include excision with primary closure or secondary granulation.
Purpose of the Study:
- To compare the efficacy of two surgical methods for chronic pilonidal disease: excision and primary closure versus excision and healing by secondary granulation.
- To evaluate healing time, cure rates, and recurrence rates for each method.
Main Methods:
- A randomized trial involving 100 patients with chronic pilonidal disease.
- Patients were assigned to either excision and primary closure or excision and secondary granulation.
- Follow-up averaged 29 months.
Main Results:
- Primary healing occurred in 98% of the primary closure group versus 72% in the secondary granulation group.
- Mean healing time was significantly shorter for primary closure (10.3 days) compared to secondary granulation (13 weeks).
- No significant difference in cure rate after the first operation was observed; recurrence rates were 20% for primary closure and 12% for secondary granulation.
Conclusions:
- Excision with primary closure leads to significantly faster initial healing and shorter overall healing times for chronic pilonidal disease.
- Despite similar cure rates, primary closure is suggested as the preferable method due to reduced healing duration and sick leave.
- Factors like stiff hair and anaerobic bacteria were linked to initial healing failure but not recurrence.