Shams Nadeem Alam, Azfaruddin, Rahil M Rahman.
Excision with primary closure of pilonidal sinus.
Pak J Surg Jan ;22(2):82-5.

Objective: To evaluate the efficacy of Primary Closure of the Pilonidal Sinus after excision, especially in terms of hospital stay, time of return to work, complications and recurrence. Study Design: Interventional Prospective study carried out between July 2002 to June 2005. Setting: Surgical Unit III, Abbasi Shaheed Hospital and Karachi Medical & Dental College. Patients: Twenty eight patients with Pilonidal Sinus above the age of 15 years. Methodology: The biodata, symptoms and signs of these patients were recorded and appropriate investigations performed. The Pilonidal sinus was excised and Primary closure performed, using cavity (dead space) obliterating tension suturing and vertical mattress sutures with polypropylene. The tension sutures were removed on the 3rd day and the vertical mattress sutures on the 10th day. Results: Out of the 28 patients that were operated upon, one (3.57%) developed recurrence, four (14.28%) wound infection and one wound dehiscence. Return to active work took a mean of 13.2 days (range 7-18 days). There was no mortality in this study. Conclusion: Prevention of recurrence of the Pilonidal Sinus is attributed to the flattening of the natal cleft and a hairless scar line. Excision of Pilonidal Tract followed by Primary closure offer the advantages of quicker healing time, fewer post-operative visits and shorter time off work. When a primary closure can be carried out, it should be routinely considered for the socioeconomic benefit and comfort of the patient.

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