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Outcome of the lay open vs. excision and primary closure treatment modalities for chronic sacrococcygeal pilonidal sinus in the local Saudi Arabian community

Bader Hamza Shirah, Hamza Assad Shirah.

Abstract
Background and Objectives: Sacrococcygeal pilonidal sinus is a chronic condition for which the treatment options remain controversial based on the high recurrence rates. Before 1997, excision and primary closure was the most popular method offered in our local community surgical practice. In this study, we aim to evaluate the results of treatment outcomes of the lay open method offered in 1997 to our local community patients and compare it to the excision and primary closure method, hoping it may help in opening up wider frontiers in the surgical practice on our local community to provide the best health care.
Materials and Methods: Between January 1997 and December 2011, 600 patients with chronic sacrococcygeal pilonidal sinus were included in our study. 443 were male and 157 were female (age range: 16–39). The lay open method was performed on 300 patients who agreed to the newly offered procedure, and excision with primary closure was performed on the other 300 patients that refused surgery with the lay open method.
Results: The recurrence rate was 0% for the lay open technique, and 3% for the excision with primary closure method. All patients had undergone 5 years of follow-up.
Conclusion: When the lay open technique is performed in a meticulous and carefully prepared manner with superb postoperative care and regular follow-up, it is more promising than excision with primary closure in treating chronic sacrococcygeal pilonidal sinus, and may successfully achieve a zero (0%) recurrence rate, low postoperative complications, and acceptable cosmetic wounds.

Key words: Lay open, excision, primary closure, chronic sacrococcygeal pilonidal sinus, sitz bath


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