Clinical features and surgical management of sacrococcygeal pilonidal sinus: Experience of a peripheral hospital in Saudi Arabia
Objective(s) Observe age-and gender specific occurrence, see if sacrococcygeal pilonidal sinus disease (SPD) remains more among obese patients, and, evaluate its surgical outcome with some modification.
Design: Prospectively designed interventional study
Setting: Department of Surgery, Hotat Sudair Hospital (90-beded secondary care) located 180 km away from Riyadh city.
Subjects: Twenty four male Saudi patients with the complaints of pain and discharge from natal cleft area who had underwent surgery.
Surgical intervention: All patients underwent surgery following either "open" or "closed" techniques. An elliptical oblique incision away from midline was made- differing from Karydakis technique. Our modification was somewhat similar to Kitchen which was aimed to minimize normal-tissue loss and reduced tension leading to stronger scar.
Main Outcome Measure(s) Mean surgery time, mean wound healing and hospital stay, and recurrence rate, and complication(s).
Results Mean age was 22.2±4.9 years and mean BMI was 28.7±4.46 (83.3% being obese or overweight). Surgery was performed following closed (67%) and open (33%) excisions. Mean surgery time was 33.9±10.1 minutes. Mean wound healing was 20.4±9.51 days differing with surgical techniques (p<0.00) but inversely proportional to surgery-time (p<0.00).Mean hospital stay was 4.89±1.01 days. One recurrence and 5 complications occurred in open excision (p<0.03) when followed up for 10.83±6.76 months. Conclusion SPD remains common among obese males. Primary closure though seemed promising, open method remains better for extensive, infected/recurrent cases. Eccentric-oblique incision is an effective modification where midline is more preserved to reduce tension and healthy scar. More studies be conducted to confirm or refute our observation(s).
Dr. Hassan Al Traifi Dr., Kazi Selim Anwar Dr., Mujahid Ashraf Dr., and Wasim Sayeed Malik Dr.
"Clinical features and surgical management of sacrococcygeal pilonidal sinus: Experience of a peripheral hospital in Saudi Arabia,"
World Journal of Colorectal Surgery:
1, Article 7.
Available at: http://services.bepress.com/wjcs/vol1/iss1/art7