1. Introduction
Pilonidal sinus disease (PSD) is one of the common inflammatory process of the natal cleft with an incidence of 26 per 100 000 population[1]. It mainly affects the young adults between the 15 – 25 years old and the female to male ratio is between 3:1 and 4:1 [2-4]. PSD can result in no apparent symptoms is specified by one or more non-inflamed pits in the natal cleft and incidentally identified; an abscess formation; or a chronic form[5].
PSD is a chronic and inflammatory disease of the sacrococcygeal region[6]. Although the exact pathogenesis of PSD is still controversial, the most widely accepted view of its pathogenesis is that shed hairs cause a foreign body reaction and inflammation after penetrating into subcutaneous cysts in the natal cleft[2, 7]. Rigidity of body hair, two or less number of baths in a week, time spent more than six hours on a seat per day[8, 9], deep natal cleft and family history were found as predisposing risk factors for PSD [8, 10].
Many treatment modalities have produced since 1950’s [11], the optimal treatment approach of this disease is one of the most widely discussed points in the surgery [3, 12]. Surgical treatment of PSD differing from the simple incision, curettage, drainage, secondary healing to excision-flap sliding[3]. Excision and open wound healing is the method one of thr most frequently used in the world and this method still continues to be used because it is simple, easy to learn and reproducible [13]. However, the main handicap is quite a long wound healing time, is reported as 1.5 to 3 months, and a delayed return to school or work [5, 13]. Midline closure shortens significantly the healing time, but it causes a considerable incidence of wound dehiscence ranging between 14 and 74%[5, 13, 14]. Of the off-midline procedures, the Karydakis flap [15], the Limberg flap[16], and cleft lift [17], gained popularity and overcame the disadvantages of midline closure regarding with wound dehiscence. Though these flap procedures have been widely desired technics by surgeons, the off-midline procedures have led to patients to feel various concerns due to the sophisticated nature of the procedures, resulting in long hospital stay and the cosmetic problem[6, 18-20].
Minimally invasive procedures for the treatment of PSD was described firstly by Lord and Miller 1965 [21]. In parallel with the technical improvement in the surgery, the various minimally invasive approaches have been produced such as follicle removal[22], using trephine instead of knife to clean the underlying cavity [23]. All these techniques have important advantages such as quick healing and fast return to work, but it could be applied in previously untreated patients with mild disease and the high recurrence rate was estimated as 20 to 25%[13].
Sinusectomy was first described by Soll et al. 2008[24]. The main advantage of this procedure to pit picking and other variations is a complete excision of sinus tract and that is performed by close tracing of the tract instead of wide excision[5, 25]. The promising recurrence rate was observed after sinusectomy, the overall recurrence rate was reported as 7% by Soll et al. according to the long term outcome of 257 patients[25].
The aim of the present study was to assess the efficacy of sinusectomy and primary closure (SPC) in all cases include primary or recurrent patients, simple or complicated with multiple pits or multiple sinus tracts. To compare the results of SPC and regarding with the incidence of postoperative recurrence and the incidence of complications, the procedure of excision and primary closure (EPC) was chosen due to most commonly used treatment modality in complicated and non-complicated cases for a long time.