Twenty years exeperiences in treatment of pilonidal sinus with primary Closure.

Pilonidal sinus is a common disease among young adults after the puberty while it is quite rare in subjects older than 40 years. The incidence in the third and fourth decade and the prevalence of the disease in males, with a rate of 3:1 are probably related to androgen secretion. In case of abscess most of the authors suggest a conservative approach with incision and drainage under local anesthesia, delaying the definitive treatment by complete excision of the sinus. Nevertheless, surgical treatment of the sinus has an high recurrence rate and as shown by the several techniques proposed, choice primarily depends on the experience of the surgeon and on the consensus of the patient. Methods: From 1985 to 2004, 229 patients (171 M, 58 F) aged between 16 and 35 years, affected by pilonidal sinus were treated by complete excision of the sinus and primary closure. Results: Primary healing was achieved in 208 patients (91%) in an average time of 11.9 days. Secondary healing was achieved in 21 patients (9%) in 16–19 days. Mean postoperative hospital-stay was 1.9 days and average time off work was 16 days. Recurrent pilonidal sinus was observed in 10 patients with a mean follow-up of 30 months (range 12–60). Discussion: On the basis of their experience, the authors conclude that complete excision of pilonidal sinus with primary closure provides good results in terms of healing, morbidity, early return to work and recurrence rate and can be considered the treatment of choice of pilonidal sinus.