ABSTRACT

Background: Pilonidal sinus is a chronic intermittent disease that typically affects the sacrocygeal zone. It usually affects young and middle-aged males. For more than a century, surgeons have have been using different treatment modalities to treat this disease, including both simple and complex procedures like laying open of tract, simple excision, marsupialization, karydakis procedure and limberg flap closure.

Aim: To compare the outcome of rhomboid flap excision versus ellipticalexcision in primary closure for management of patients undergoing surgery for sacrococcygeal pilonidal sinus.

Methods: A Randomized controlled trial was conducted in West Surgery Ward,  Department  of  Surgery,  Mayo  Hospital, Lahore from August 17, 2016 to July 17, 2017. This study included 120 patients suffering acute primary sacrococcygeal pilonidal sinus. Patients were allocated randomly  into groups A & B: One group included patients with Excision and primary closure  while other included patients undergoing modified Limberg flap procedure respectively.  Postoperative complications, length of hospital stay and duration of disease were recorded. Using SPSS v24.0 the data was entered and analysed..

Results: Overall mean age of the patients was 30.15±6.12 years. In Group-A & B, mean duration of disease  was 14.82±3.34 and 7.67±1.73 days respectively. Mean hospital stay was 4.34±1.59 days in Group-A, while  it was 3.43±1.10 days in Group-B. Comparing group A & B, rates of wound infection, edema and wound dehiscence were 8(13.1%) vs 3 (4.9%),  7(11.5%) vs 2 (3.3%) and 4(6.6%) vs 1(1.6%) respectively.

Conclusion: The outcome of rhomboid excision with limberg flap closure is safer for people having sacrococcygeal pilonidal sinus surgery than for elliptical excision with primary closure in terms of hospital stay, wound dehiscence, wound infection and oedema.

Keywords: Pilonidal sinus, simple excision, Rhomboid excision, limberg flap