No clear benefit was shown for open healing over surgical closure. A clear benefit was shown in favour of off-midline rather than midline wound closure. When closure of pilonidal sinuses is the desired surgical option, off-midline closure should be the standard management.
Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease.
The purpose of the study was to compare the outcome of excision and primary closure with that of rhomboid excision and the Limberg flap procedure in patients with primary sacrococcygeal pilonidal disease (SPD).
                Two hundred consecutive patients with SPD were randomly allocated to undergo either excision and primary closure (group 1, n = 100) or rhomboid excision and the Limberg flap procedure (group 2, n = 100). Duration of operation, postoperative pain, time to first mobilization, length of hospital stay, postoperative complications, time to resumption of work, recurrence and time to recurrence were recorded for all patients.
                : Duration of operation was longer in group 2 than in group 1 (P = 0.001). However, postoperative pain was less (P < 0.001), mobilization earlier (P < 0.001), duration of hospital stay shorter (P < 0.001), time to resumption of work shorter (P < 0.001) and postoperative complications fewer (P < 0.001) in group 2. During a median follow-up of 28 months, no recurrence was detected in patients in group 2 versus 11 patients in group 1 (P = 0.001).
                Because of its low complication rate and acceptable long-term results, rhomboid excision and the Limberg flap procedure is preferable to simple excision and primary closure in the treatment of SPD.
                Copyright 2005 British Journal of Surgery Society Ltd.