A Comparison between the Tie-over and Closed Suction Drainage Therapeutic Strategies in Patients Suffering from Sacral Pilonidal Sinus
Authors:   General Surgery Department, Alborz University of Medical Sciences, Karaj, Iran, Ahmadinejad Mojtaba , Ahmadi Koorosh , Khademhoseini Peyman ,   Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran, Ahmadinejad Izadmehr ,   Iran Atomic Energy High School, Iran, Hashemian Amir Masoud ,   Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Published: July 2023

Background and Objectives: Pilonidal sinus is a disease in the sacrococcygeal region diagnosed through the purulent discharges of the above-said region. Although the exact pathology and etiology of those suffering from pilonidal is not clear yet, the presence of hair seemingly plays a major role in the process of infection and the granulation tissue. Several techniques have been identified for pilonidal surgery. These techniques primarily fall within two categories: Primary repair and Lay open. One of the setbacks of the primary repair method is the creation of a dead area under the wound which can result in blood accumulation and seroma. To solve the problem of removing the dead space, there are two solutions. The first method utilizes a close suction drain, when the wound discharges are over, the drain is removed. The second technique is called Tie-over where different layers of the wound are pushed close to one another and the dead region vanishes. The present research seeks to compare Tie-over and Closed Suction Drainage methods through random clinical trial in order to introduce the superior technique for faster recovery and reduction of the economic load on the patient. Methods: Some 64 patients suffering from sacral plonidal sinus aging from 15 to 50 in Shohadaye Ashayer Hospital of Khoram Abad in 2013 were selected for the research based on the inclusion criteria. The demographic information of them was collected through questionnaires. The patients were randomly divided into two groups undergoing (A) Tiover and (B) Closed Suction Drainage surgeries. Other information such as return to normal activity and total recovery time was also completed through the questionnaire. SPSS software was used to conduct statistical analysis. Results: The results of the statistical analysis showed that the two groups were similar to one another in terms of age, gender, marital status, job, and literacy. A significant difference was observed only between the level of satisfaction (P-value = 0.035) in groups A and B concerning the factors studied after the operation. The post-operation recurrence of pilonidal sinus among those who smoked cigarettes and had undergone Closed Suction Drainage was significantly greater than the non-smokers (P-value=0.011). As of the group undergoing Tie-over surgery, the difference between the patients’ satisfaction in terms of their age was statistically significant and the highest level of satisfaction was observed among those aging 25 to 34 (90%) (P-value=0.023). Conclusion: In sacrococcygeal pilonidal cyst surgery, no difference was observed except for the difference in the level of satisfaction. More satisfaction was observed using the Tiover method.