A SIMPLE AND EFFECTIVE SURGICAL TREATMENT OF PILONIDAL SINUS: ASIMMETRIC EXCISION AND PRIMARY CLOSURE

Abstract

Ninety two paitents with pilonidal sinus were treated using asymetric elyptical excision and primary closure (Karydakis' operation) between June 1995 and June 1998 were evaluated and the surgical treatment procedures were discussed in this study. Several different methods for treatment of pilonidal sinus have been described. Especially high recurrence rate that developed after some surgical procedures causes an important time off work among young population. Surgical treatment methods should not only remove the obvious lesion but also should be prevent the causative factors. Recurrence rates, inpatients stay, time off work are important considerations after surgical procedure. Twenty four cases with pilonidal abscesses, 2 cases with wide gluteal involvement and five cases that did not followed up were excluded. The procedures were done under general anaesthesia. Karydakis' operation consists of an eccentric, elyptical excision of the affected tissue, mobilization of flap to the sacrococcygeal fascia and the suturing of its edge to the lateral one. Eighty six patients were male and 6 were female. Mean age was 22.1 years. Mean history of disease was 4.2 years. Mean operation cost was 422 dolars and mean operation time was 32 minute. 18 of cases had been operated at least once before. There were 3 wound infections, 2 wound breakdown, 3 haematomas and 1 recurrence in our series. Mean hospital stay was 2.8 days and mean time off work was 13 days. The prevention of causative factors include the removal of the vulnerable raphe, the avoidance of any wound scar in the intergluteal fold and thus the prevention of reacumulation of hair. Asymmetric excision and primary closure provide these objectives and it seems to be the method of choice because of low recurrence rate, low complication, minimal inpatients stay, minimal time off work and low operation time and cost.