A Comparison between the Outcomes of Tie-Over and Closed Suction Drainage Techniques in the Management of Sacrococcygeal Pilonidal Sinus Disease

Document Type : Original Article (s)

Authors

1 Assistant Professor, Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Associate Professor, Department of General Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of General Surgery, Jondi Shapoor University of Medical Sciences, Ahvaz, Iran

4 Student of Medicine, Student Research Committee, Medical Students Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

5 Resident, Department of Surgery, Medical Education Research Center, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Pilonidal disease is a painful condition usually occurring in the intergluteal region. The most common procedure for surgical treatment of pilonidal disease in Alzahra Hospital (Isfahan, Iran) is excision and primary closure. However, this method could be complicated by creating a dead space at the surgical site. In this clinical trial, we compared two techniques to minimize complications following surgery.Methods: This clinical controlled trial was performed in Alzahra Hospital (Isfahan, Iran) during 2007-2008. Patients were randomized into either tie over technique group (group A, n = 54) or closed suction drainage group (group B, n = 54). The incidence of complications was evaluated by means of a specific questionnaire at the time of surgery and during follow-up visits. Data was analyzed using SPSS13.Findings: This study included 108 patients (94.4% males and 5.6% females). The mean age of subjects was 25.08 ± 3.6 years. The prevalence of complications (disease recurrence, surgical wound infection, wound dehiscence, and seroma collection) did not significantly differ between the two groups. Duration of operation in group A was significantly longer than group B (P < 0.001).  Conclusion: Based on our data, there were no differences between the outcomes of tie over and closed suction drainage techniques for surgical management of sacrococcygeal pilonidal sinus disease.

Keywords


  1. Townsend CM, Beauchamp RD, Evers BM, Mattox K. Sabiston Textbook of Surgery: The Biological Basis of Modern Practicsurgical Practice. 17th ed. Philadelphia, PA: Saunders; 2004.
  2. Baker RJ, Fischer JE. Mastery of Surgery. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2001.
  3. Chiedozi LC, Al-Rayyes FA, Salem MM, Al-Haddi FH, Al-Bidewi AA. Management of pilonidal sinus. Saudi Med J 2002; 23(7): 786-8.
  4. Matter I, Kunin J, Schein M, Eldar S. Total excision versus non-resectional methods in the treatment of acute and chronic pilonidal disease. Br J Surg 1995; 82(6): 752-3.
  5. Seleem MI, Al-Hashemy AM. Management of pilonidal sinus using fibrin glue: a new concept and preliminary experience. Colorectal Dis 2005; 7(4): 319-22.
  6. Akinci OF, Coskun A, Uzunkoy A. Simple and effective surgical treatment of pilonidal sinus: asymmetric excision and primary closure using suction drain and subcuticular skin closure. Dis Colon Rectum 2000; 43(5): 701-6.
  7. Onishi K, Maruyama Y. Sacral adipofascial turn-
  8. over flap for the excisional defect of pilonidal sinus. Plast Reconstr Surg 2001; 108(7): 2006-10.
  9. Al-Khayat H, Al-Khayat H, Sadeq A, Groof A, Haider HH, Hayati H, et al. Risk factors for wound complication in pilonidal sinus procedures. J Am Coll Surg 2007; 205(3): 439-44.
  10. McGuinness JG, Winter DC, O'Connell PR. Vacuum-assisted closure of a complex pilonidal sinus. Dis Colon Rectum 2003; 46(2): 274-6.
  11. Gurer A, Gomceli I, Ozdogan M, Ozlem N, Sozen S, Aydin R. Is routine cavity drainage necessary in Karydakis flap operation? A prospective, randomized trial. Dis Colon Rectum 2005; 48(9): 1797-9.
  12. Lynch JB, Laing AJ, Regan PJ. Vacuum-assisted closure therapy: a new treatment option for recurrent pilonidal sinus disease. Report of three cases. Dis Colon Rectum 2004; 47(6): 929-32.
  13. Spivak H, Brooks VL, Nussbaum M, Friedman I. Treatment of chronic pilonidal disease. Dis Colon Rectum 1996; 39(10): 1136-9.
  14. Rosen W, Davidson JS. Gluteus maximus musculocutaneous flap for the treatment of recalcitrant pilonidal disease. Ann Plast Surg
  15. ; 37(3): 293-7.
  16. Bozkurt MK, Tezel E. Management of pilonidal sinus with the Limberg flap. Dis Colon Rectum 1998; 41(6): 775-7.
  17. Mansoory A, Dickson D. Z-plasty for treatment of disease of the pilonidal sinus. Surg Gynecol Obstet 1982; 155(3): 409-11.
  18. Allen-Mersh TG. Pilonidal sinus: finding the right track for treatment. Br J Surg 1990; 77(2): 123-32.
  19. Da Silva JH. Pilonidal cyst: cause and treatment. Dis Colon Rectum 2000; 43(8): 1146-56.
  20. Karydakis GE. Easy and successful treatment of pilonidal sinus after explanation of its causative process. Aust N Z J Surg 1992; 62(5): 385-9.
  21. Kitchen PR. Pilonidal sinus: experience with the Karydakis flap. Br J Surg 1996; 83(10): 1452-5.
  22. .Anyanwu AC, Hossain S, Williams A, Montgomery AC. Karydakis operation for sacrococcygeal pilonidal sinus disease: experience in a district general hospital. Ann R Coll Surg Engl 1998; 80(3): 197-9.
  23. Milito G, Cortese F, Casciani CU. Rhomboid flap procedure for pilonidal sinus: results from 67 cases. Int J Colorectal Dis 1998; 13(3): 113-5.
  24. Abu Galala KH, Salam IM, Abu Samaan KR, El Ashaal YI, Chandran VP, Sabastian M, et al. Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg 1999; 165(5): 468-72.
  25. Bozkurt MK, Tezel E. Management of pilonidal sinus with the Limberg flap. Dis Colon Rectum 1998; 41(6): 775-7.
  26. Al-Jaberi TM. Excision and simple primary closure of chronic pilonidal sinus. Eur J Surg 2001; 167(2): 133-5.
  27. Mandel SR, Thomas CG, Jr. Management of pilonidal sinus by excision and primary closure. Surg Gynecol Obstet 1972; 134(3): 448-50.