Comparison of Outcomes of Open and Closed Surgical Procedures in Pilonidal Cysts Excision: A Randomized Clinical Trial Study
Abstract
Background: Treatment of pilonidal sinus involves the use of various surgical procedures, most of which are associated with many complications and problems. Meanwhile, open and closed surgical procedures are two common surgical procedures for the treatment of patients with pilonidal sinus disease. The aim of this study is to compare the outcomes of open and closed surgical procedures in pilonidal cysts excision.
Methods: This study was a randomized clinical trial that was performed on patients with pilonidal sinus referred to Shahid Beheshti Hospital of Yasuj University of Medical Sciences, Yasuj, Iran. Patients having inclusion criteria were assigned to 2 groups; first group for open surgical procedure (n:30) and second group for closed surgical procedure (n:30) using a simple randomized method. The data gathering tools were a demographic data form and a visual analog scale (VAS). Two types of open and closed surgery procedures were performed randomly on patients. Data were analyzed by SPSS-16 software using mean, standard deviation, independent t-test, Chi-square or Fisher exact test.
Results: The results showed that the outcomes of recurrence of the disease (P = 0.001), wound infection (P = 0.003), and duration of surgery (P = 0.001) in open surgical procedure were significantly lower than the closed surgical procedure.
Conclusions: Considering the better outcomes of open surgical procedure in terms of patient satisfaction after surgery and lower additional costs, the open surgical procedure is suggested for the treatment of pilonidal sinus - if one of these two methods should be selected by the surgeon.
References
Ahmed AK, McCallum I, King PM, Bruce J. Healing by primary versus secondary intention after surgical treatment for pilonidal sinus. Cochrane database of systematic reviews 2010.
Ahmadinejad M, Azizpourfard Y, Snysl Bchary E. A comparison of prognosis in patients with pilonidal sinus surgery admitted to Shohada hospital of Khorramabad during 2005-2012. Yafteh 2013; 15:30-6.
Hemmati HR, Ghorbani R, Nayyeri Torshizi E. Recurrence rate in the pilonidal sinus after excision with or without primary closure. Koomesh 2013; 15:78-82.
Sequeira JB, Coelho A, Marinho AS, Bonet B, Carvalho F, Moreira-Pinto J. Endoscopic pilonidal sinus treatment versus total excision with primary closure for sacrococcygeal pilonidal sinus disease in the pediatric population. J Pediatr Surg 2018; 53:2003-7.
Hull TL, Wu J. Pilonidal disease. Surg Clin North Am 2002; 82:1169-85.
Chintapatla S, Safarani N, Kumar S, Haboubi N. Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical options. Tech Coloproctol 2003;7:3-8.
Keshvari A, Fazeli M-S, Kazemeni A, Meisami A, Nouri-Taromloo M-K. Prospective evaluation of outcome of karydakis flap for sacrococcygeal pilonidal disease. Tehran Univ Med J 2015; 72:823-30.
Testini M, Piccinni G, Miniello S, Di Venere B, Lissidini G, Nicolardi V, et al. Treatment of chronic pilonidal sinus with local anaesthesia: a randomized trial of closed compared with open technique. Colorectal Dis 2001; 3:427-30.
Popeskou S, Christoforidis D, Ruffieux C, Demartines N. Wound infection after excision and primary midline closure for pilonidal disease: risk factor analysis to improve patient selection. World J S 2011; 35:206-11.
McCallum IJ, King PM, Bruce J. Healing by primary closure versus open healing after surgery for pilonidal sinus: systematic review and meta-analysis. BMJ 2008; 336:868-71.
Chiedozi LC, Al-Rayyes FA, Salem MM, Al-Haddi FH, Al-Bidewi AA. Management of pilonidal sinus. Saudi Med J 2002; 23:786-88.
Bozkurt MK, Tezel E. Management of pilonidal sinus with the Limberg flap. Dis Colon Rectum 1998; 41:775-7.
Toubanakis G. Treatment of pilonidal sinus disease with the Z-plasty procedure (modified). Am Surg 1986; 52:611-12.
Jabbar MS, Bhutta MM, Puri N. Comparison between primary closure with Limberg Flap versus open procedure in treatment of pilonidal sinus, in terms of frequency of post-operative wound infection. Pak J Med Sci 2018; 34:49-53.
Kamran H, Ahmed A, Ali Khan I, Khan R, Asad S, ud din Khattak I. Pilonidal Sinus: A Comparative Study of Open Versus Closed Methods of Surgical Approach. JIIMC 2017; 12:111-15.
Hockenberry MJ, Wilson D. Wong's Essentials of Pediatric Nursing9: Wong's Essentials of Pediatric Nursing: Elsevier Health Sciences; 2013.
Yang JH. The effects of foot reflexology on nausea, vomiting and fatigue of breast cancer patients undergoing chemotherapy. J Korean Acad Nurs 2005; 35:177-85.
Rashidian N, Vahedian-Ardakani J, Baghai-Wadji M, Keramati MR, Saraee A, Ansari K, et al. How to repair the surgical defect after excision of sacrococcygeal pilonidal sinus: a dilemma. JWC 2014; 23:630-33.
Haji Barati B, Ghafuri A. Surgical management of pilonidal sinus patients by primary and secondary repair methods: a comparative study. Tehran Univ Med J 2010; 68:553-58.
Ertan T, Koc M, Gocmen E, Aslar AK, Keskek M, Kilic M. Does technique alter quality of life after pilonidal sinus surgery? Am J Surg 2005; 190:388-92.
Rao MM, Zawislak W, Kennedy R, Gilliland R. A prospective randomised study comparing two treatment modalities for chronic pilonidal sinus with a 5-year follow-up. Int J Colorectal Dis 2010; 25:395-400.
Ommer A, Pitt C, Albrecht K, Marla B, Peitgen K, Walz MK. [Pilonidal Sinus -- Primary Closure also in Case of Abscess?]. Zbl Chir 2004; 129:216-19.
Lorant T, Ribbe I, Mahteme H, Gustafsson UM, Graf W. Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial. Dis Colon Rectum 2011; 54:300-5.
Gilani S, Furlong H, Reichardt K, Nasr A, Theophilou G, Walsh T. Excision and primary closure of pilonidal sinus disease: worthwhile option with an acceptable recurrence rate. Ir J Med Sci 2011; 180:173-76.
Toccaceli S, Persico Stella L, Diana M, Dandolo R, Negro P. Treatment of pilonidal sinus with primary closure. A twenty-year experience. Chir Ital 2008; 60:433-38.
