Pilonidal sinus: excision and primary closure with a lateralised wound - the Karydakis operation

Area of Science:

• Surgical Procedures
• Proctology
• Wound Healing

Background:

• Pilonidal sinus disease is a common condition affecting the natal cleft.
• Recurrence rates after traditional surgical interventions remain a concern.
• Minimally invasive techniques are sought to improve patient outcomes.

Purpose of the Study:

• To evaluate the efficacy of the Karydakis operation in treating postanal pilonidal sinus.
• To assess the recurrence rates and complication profile of this surgical technique.
• To determine if modifying the natal cleft geometry impacts disease recurrence.

Main Methods:

• A personal series of forty-five patients with postanal pilonidal sinus underwent the Karydakis operation.
• The procedure involves an eccentric elliptical incision, undermining, and advancement of tissue to create a lateral scar and shallower cleft.
• Forty patients were followed up for an average of thirty-three months.

Main Results:

• The Karydakis operation resulted in a low recurrence rate.
• Complications included two wound haematomata and four wound infections.
• One of the two recurrences was noted to be outside the surgical scar.

Conclusions:

• Flattening the natal cleft and closing the skin away from the midline are key to achieving a low recurrence rate.
• The Karydakis operation is an effective surgical option for postanal pilonidal sinus.
• Careful wound closure technique is crucial for minimizing complications and recurrence.