Conservative Sinusectomy vs. excision and primary off-midline closure for pilonidal disease: a randomized controlled...

Area of Science:

• General Surgery
• Surgical Innovation

Background:

• Pilonidal sinus disease (PD) is a prevalent condition causing significant patient discomfort and work absence.
• Current surgical management lacks a definitive consensus, necessitating comparative studies for optimal treatment strategies.

Purpose of the Study:

• To compare the efficacy of conservative sinusectomy (S) versus excision and paramedian primary closure (PC) for chronic pilonidal sinus disease.
• To evaluate healing rates, pain, time off work, patient satisfaction, and recurrence at one year.

Main Methods:

• A randomized controlled trial adhering to CONSORT standards.
• Inclusion of patients with chronic PD, excluding acute abscesses, post-surgical recurrence, and complex cases requiring flap reconstruction.
• Randomization of patients to either sinusectomy (S) or paramedian primary closure (PC) with defined primary and secondary outcome measures.

Main Results:

• The study was prematurely stopped due to observed outcome discrepancies.
• Paramedian primary closure (PC) demonstrated significantly higher healing rates at 3 weeks (50%) compared to sinusectomy (S) (13.3%; p=0.01).
• Median healing time was shorter for PC (34 days) than for S (54 days) (p=0.025), with similar rates of outpatient visits, time off work, analgesia use, and 1-year recurrence.

Conclusions:

• Paramedian primary closure (PC) is associated with faster healing for pilonidal sinus disease compared to conservative sinusectomy (S).
• Both surgical techniques exhibit comparable healthcare burdens and long-term recurrence rates.