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.
Comparison between three therapeutic modalities for non-complicated pilonidal sinus disease.
To evaluate the outcome of each of the three methods used to treat pilonidal sinus disease.
                A prospective blind randomised study.
                Between April 2000 and February 2003, 83 patients (68 male and 15 female), aged between 19 and 31 years (mean 26.6), scheduled for elective operations for pilonidal sinus disease. Patients were randomly assigned to receive one of three excisional surgical procedures. Group A consisted of 28 patients (22 males and six females) and underwent wide resection of the skin and subcutaneous tissue of the natal cleft, followed by primary closure of the wound in two layers after insertion of suction drain. Group B consisted of 26 patients (22 males and four females) and underwent wide resection of the skin and subcutaneous tissue and their wounds left opened for secondary intention healing. Group C consisted of 29 patients (24 males and five females) and underwent limited excision of the fistulous tract and their wounds were left opened for secondary intention healing. Patients were followed-up for 15 to 48 months post-operatively. Demographic data, operative time, hospital stay, operative blood loss, post-operative pain, wound healing time and patient's satisfaction were recorded.
                The limited excision group of patients had a highly significant shorter operative time than the closed wound group of patients (p<0.001). They also had the shortest hospital stay, operative blood loss and post-operative pain (p<0.001). The closed wound group of patients showed significantly shortest wound healing time, followed by the limited excision group of patients; the wide excision group of patients showed the longest healing time. Apart from the minimal non-significant elevation of the rate of recurrence in the closed wound group of patients, there was no difference between the three groups. All recurrent cases were obese patients and presented within the first six months after operations.
                Limited excision of a pilonidal sinus represents one of the best therapeutic options. The result of this method is comparable with the more aggressive frequently used excisional method, and it has the advantage of having a shorter convalescence and better patient satisfaction.