Comparison of Outcomes of Open and Closed Surgical Procedures in Pilonidal Cysts Excision: A Randomized Clinical Trial Study

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. Based on the findings of this study, it was found that the surgical duration between the two groups of open and closed surgical procedure was significant in terms of shortening the duration of open surgical procedure than the closed one. The results were in line with the findings of Amini Moghadam et al (14). They showed that the surgery duration in open surgical procedure (13.9 min) was significantly more than the closed surgical procedure (20.1 min). Regarding the duration of return to work between two groups, the results of this study showed that the duration of return to work in the closed surgical procedure was less than the open surgical procedure and the patients undergoing the closed surgery recovered quickly. Toccaceli et al. (25), after 20 years of experience and primary closure surgery, showed that the primary closure (closed surgical procedure) of pilonidal sinus was associated with good results in terms of the quick recovery and return to the work of patients and could be considered as a selective treatment for the pilonidal sinus. So, their findings are consistent with the results of the present study. Also, the findings of the present study showed that there was no statistically significant relationship between the duration of hospitalization in open and closed surgical procedures. Therefore, the results of this study are in line with the findings of Amini Moghadam et al (14). The results of their study showed that the mean hospitalization duration in the closed and open surgical procedures were 14.8 hours and 15.3 hours, respectively. These results were not statistically different from each other.