Partial primary closure in sacrococcygeal pilonidal sinus: Modified with suture technique.
1Department of General Surgery, University of Health Sciences Umraniye Training and Research Hospital, İstanbul, Turkey.
Asian Journal of Surgery
|July 25, 2021
Summary
Partial primary closure (PPC) offers faster healing for complicated pilonidal sinus disease (PSD) but has higher infection rates. The Karydakis flap (KF) is recommended for clean cases. Both techniques show similar overall complication rates.
Area of Science:
- Surgical techniques for pilonidal sinus disease (PSD).
- Wound healing and complication analysis in surgical interventions.
- Comparative study of surgical methods in proctology.
Background:
- Pilonidal sinus treatment aims to minimize complications, accelerate healing, and reduce recurrence.
- Existing invasive and minimally invasive surgical methods for PSD have limitations.
- Postoperative complications remain a significant challenge in pilonidal surgery.
Purpose of the Study:
- To compare the efficacy of the Karydakis flap (KF) technique and partial primary closure (PPC) with suture modification for pilonidal sinus disease.
- To evaluate postoperative complications, healing times, and recurrence rates between the two surgical techniques.
Main Methods:
- A randomized study involving 96 patients diagnosed with pilonidal sinus disease (PSD).
- Patients were assigned to either the partial primary closure (PPC) group (n=46) or the Karydakis technique (KF) group (n=50).
- Suture modification was applied to the partial primary closure technique.
Main Results:
- Partial primary closure (PPC) showed a shorter, though not statistically significant, hospitalization stay compared to the Karydakis technique (KF).
- Healing time was longer in uncomplicated cases for PPC (p=0.200) but significantly shorter for complicated cases (p<0.05).
- Abscesses and hematomas were absent in the PPC group; however, surgical site infections were more frequent (21.7% vs. 10% in KF), leading to similar overall complication rates.
Conclusions:
- Partial primary closure (PPC) with suture modification is a viable alternative to off-midline techniques for clean and chronically infected pilonidal sinus disease, excluding cellulitis or abscess.
- The Karydakis flap (KF) technique is recommended for clean or asymptomatic pilonidal sinus cases.
- Postoperative complications like abscess, hematoma, and seroma can delay wound healing, particularly with off-midline techniques.
