Surgical treatment of chronic pilonidal sinus

Chronic pilonidal sinus is an acquired skin disease resulting from chronic inflammation of an affected skin area. It creates a cyst with epithelized subcutaneous channels. The disease mostly affects younger men with elevated BMI and sedentary lifestyle being the main risk factors. The aim of this study was to compare wound healing times, seroma, wound infection and wound dehiscence frequency, average length of hospital stay and recurrence rate in patients undergoing first-time operation for chronic pilonidal sinus at the Surgery clinic of University hospital Mostar from June 2015 to June 2017, with recurrence rate monitoring for one one year after the operative procedure. The patients were divided into three groups by the type of operating procedure: excision with primary closure (23.0%), excision with healing by secondary intention (55.2%) and excision with Limberg flap closure (21.8%). Most of the patients included in this study had elevated BMI (72.4%). Patients who were operated using primary closure and Limberg flap closure had on average shorter wound healing times than patients operated with excision and secondary intention healing. Seroma frequency was highest in patients operated using primary closure (70.6%) and lowest in patients operated using Limberg flap closure (29.4%). Average length of hospital stay was 6.4 days (min 3, max 13; SD 1.919). There were no statistically significant differences in hospital stay between different types of operating procedures used. Patients operated using Limberg flap closure had two (10.5%) cases of recurrence in the one year period after the operation. There were seven (35.0%) recurrences of the disease in patients operated using primary closure and six (12.5%) recurrences in patients operated using healing with secondary intention. The difference in the number of recurrences between patients operated using primary closure, healing by secondary intention and Limberg flap closure was borderline statistically significant. We find that Limberg flap closure reduces postoperative complications and wound healing time which improves postoperative recovery.