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Randomized Controlled Trial
. 2024 Apr 16;47(2):e1073.
doi: 10.23938/ASSN.1073.

A new midline closure technique without skin sutures: Long-term outcomes of primary repair of pilonidal sinus disease

Hüseyin Tas  1 , Furkan Karahan  2
Affiliations
Randomized Controlled Trial

A new midline closure technique without skin sutures: Long-term outcomes of primary repair of pilonidal sinus disease

Hüseyin Tas et al. An Sist Sanit Navar. .

Abstract
in English, Spanish

Background: Currently, the focus regarding pilonidal sinus disease is put on the treatment techniques. The aim of the study is to compare postoperative long-term complications and recurrence of two surgical techniques.

Material and methods: From February 2015 to December 2020, male patients with pilonidal sinus disease attended at two general surgery outpatient centers were randomly assigned to either Group 1 (n=80; excision and primary closure) or Group 2 (n=80; excision and midline closure without skin sutures). Patients with recurrent or complicated pilonidal sinus or with prior surgical procedures were excluded from the study. Intergroup postoperative results and recurrence throughout the follow-up period were analyzed.

Results: Significant decrease (p<0.001) in the duration of the surgical procedure (35 to 25 minutes), length of hospital stay (one day to the day of the surgery), and of the time required to return to work (15 to 12 days) was seen for Group 2 patients. The complication rate (wound infection and seroma) was lower in Group 2 compared to Group 1 (n = 3; 3.7% vs n = 10; 12.5%; p = 0.014). During the five-year mean follow-up, five patients (6.2%) in Group 1 had recurrence compared to none in Group 2 (p = 0.023).

Conclusions: Midline primary closure method without skin sutures - easy to learn and implement and has no complication or recurrence in the long-term follow-up - may be an ideal method in cases where excision and primary repair is planned, especially in patients with sinus orifices located in the midline.

Fundamento:: Hoy en día, el foco sobre la enfermedad del seno pilonidal se centra en las técnicas de tratamiento. El objetivo del estudio es comparar dos técnicas quirúrgicas diferentes respecto a las complicaciones posoperatorias y la recidiva a largo plazo.

Metodología:: Estudio longitudinal de pacientes masculinos que acudieron a la clínica ambulatoria de cirugía general desde febrero de 2015 hasta diciembre de 2020 por enfermedad del seno pilonidal. Los pacientes se aleatorizaron en Grupo 1 (n=80, escisión más cierre primario) y Grupo 2 (n=80, escisión más cierre de la línea media sin suturas cutáneas) y se compararon los resultados. postoperatorios y las recidivas durante el seguimiento. Se excluyeron los pacientes con sinus pilonidal recurrente o complicado o con cirugía previa.

Resultados:: Los pacientes del Grupo 2 mostraron un tiempo significativamente menor (p<0,001) de cirugía (25 minutos vs 35), de estancia hospitalaria (0 vs 1 día) y de baja médica (12 días vs 15). La frecuencia de complicaciones (infección y seroma) fue menor que en el Grupo 1 (3,7% vs 12,5%; p = 0,014). Durante los cinco años de seguimiento medio, cinco pacientes del Grupo 1 recidivaron (6,2%) frente a ninguno del Grupo 2 (p=0,023).

Conclusiones:: El cierre primario de la línea media sin suturas cutáneas, fácil de aprender e implementar y que no presenta complicaciones ni recidivas en el seguimiento a largo plazo, puede ser un método ideal en los casos en los que se planifica escisión más reparación primaria, especialmente en aquellos con orificios sinusales ubicados en la línea media.

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Conflict of interest statement

Conflicts of interests: The authors declare that they have no conflict of interest.

Figures

Figure 1
Figure 1. Image of the orifices caused by skin reaction and sutures in a patient from Group 1 two weeks after surgery.
Figure 2
Figure 2. Steps of the new suturing technique: A. Elliptic incision. B. Suturing method applied through the respective layers including postsacral fascia, subcutaneous layer, opposite subcutaneous tissue, and postsacral fascia. C. An image showing the completed sutures. D. Knot placed at the mid-line of the fascia.
Figure 3
Figure 3. Images of the wound area in Day 1 (A) and Week 1 after surgery (B) from a Group 2 patient.
Figure 4
Figure 4. Postoperative images of the wound area in two patients from Group 2. A. Three months after surgery. B. Five years after surgery.
See this image and copyright information in PMC

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