Oblique Closure; Wrong Choice for the Surgical Treatment of Pilonidal Disease (Early and Unexpected Results of an RCT)

Purpose: The search for the best technique in surgical treatment of pilonidal sinus disease is still going on. In this study we present the results of oblique closure, tension free primary closure and Limberg flap reconstruction for pilonidal sinus disease. Methods: Patients were randomized into 3 groups (tension free primary closure, oblique excision and primary closure and Limberg flap reconstruction). Subcutaneous tissue was closed by 2/0 polyglactine two folds and skin was closed by 3/0 polypropylene mattress suture. Vacuumed drains were used for all the patients. All the patients were discharged from the hospital in the postoperative first day and called for follow up visit in the 14th day, 1st, 3rd and 6th month and yearly after. Results: In Limberg flap group operation time was significantly longer. Drain take off time was significantly longer in tension free primary closure group. There was no wound dehiscence in Limberg flap and tension free primary closure group; however, in oblique closure group there was 90.9% wound dehiscence. After the early evaluation, patient inclusion for oblique closure group was stopped. The study is still continuing; therefore, recurrence rates were not presented here. Conclusion: Oblique excision and primary closure is a non-physiological method for the treatment of pilonidal sinus disease.