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.
Morbidity and short term results in a randomised trial of open compared with closed treatment of chronic pilonidal sinus.
To evaluate the morbidity and short term results after open compared with closed treatment of chronic pilonidal sinus.
                Randomised control trial.
                120 of 164 patients with chronic pilonidal sinus treated between April 1987 and April 1989.
                60 patients were treated by excision and primary suture, and 60 by excision and open packing.
                Incidence of early complications (bleeding that needed treatment, wound breakdown, infection, haematoma, or wound pain), number of postoperative visits required, and length of sick leave taken.
                Those patients who underwent excision and suture had slightly but not significantly fewer early complications (16/60, 27%, compared with 23/60, 38%). Most of the early complications were the result of infection (8, 13% compared with 18, 30%, respectively). They also required fewer followup visits and less sick leave, and their wounds healed more quickly. At one year the numbers of late complications were 19 (32%) and 14 (23%), respectively.
                Excision and primary closure of chronic pilonidal sinus causes less morbidity and is more cost effective than excision and open packing. We plan a three year follow-up to see if these results are maintained.