Pilonidal sinus: minimal excision and primary closure under local anesthesia

Introduction: Many surgeons treat pilonidal sinus (PNS) by wide excision, leaving a lay open or a primary sutured midline wound. Others use more sophisticated techniques such as skin flap reconstruction. Objectives: The aim of the study was to determine the method of excising PNS minimally under local anesthesia and study its subsequent effects on wound closure and the healing process. Patients and methods: This prospective study was carried out on 30 consecutive patients with primary nonrecurrent sacrococcygeal PNS. All patients were treated surgically with minimal excision and primary closure under local anesthesia. Parameters of follow-up included wound seroma, infection, or disruption, in addition to pain, difficulty in mobilization, time off work, and recurrence. Results: The mean operative time was 38 min. Hospital stay ranged from 2 to 4 h. Healing time was 14–20 days. Three cases presented with wound seroma. One patient had a wound infection. One patient had significant wound infection and wound disruption; this patient had a recurrence after 6 months, which was treated with wide excision and rhomboid flap reconstruction. Conclusion: Minimal excision and primary closure for uncomplicated cases of PNS under local anesthesia is a safe and easy operative procedure with shorter operative time, short duration of hospital stay, less postoperative time off work, low complication rates, and low chances of recurrence.