Pilonidal Sinus: Healing by Primary Closure Versus Open Healing Surgery

Background: Twenty-six out of 10,000 young adults were found to have pilonidal sinus. Pain, chronic abcess, and psychological disorders are more pronounced when the rate of recurrence is higher. Open healing versus midline and off-midline technique has been proposed. In this review, a comparison of two techniques is proposed. The Problem: Open healing technique after extensive debridement of the inverted hair and the surrounding abcess in the fold offers a better guarantee concerning recurrence, but time to closure is higher than when using midline or off-midline immediate surgical closure. Basic/Clinical Science Advances: A systematic review and a meta-analysis of trials was developed on healing by primary closure versus open healing after surgery of pilonidal sinus. Clinical Care Relevance: The pilonidal sinus surgical cure needs to remove as completely as possible the inverted hair subcutaneous pouch, and to heal the wound as fast as possible, and to prevent recurrence. In a recent article published in the British Medical Journal, McCallum et al. presented a systematic review and meta-analysis of articles comparing healing by primary closure versus open healing after surgery of pilonidal sinus, following the Cochrane register of controlled trials. Included trials compared two or more surgical techniques on patients aged 14 years or more. Conclusion: The authors concluded that wounds heal more quickly after primary closure than after open healing but at the expense of increased risk of recurrence. Off-midline closure should become the standard management for pilonidal sinus when closure is the desired surgical option.