In order to shorten wound healing after generous excision of the pilonidal cyst and fistula, the wound was sutured immediately in the 1940s, usually through two rows of sutures (subcutaneous fatty tissue and skin suture).
 |
| Primary midline suture |
The time until the wound healed could indeed be shortened in many patients - as long as there were no wound healing disorders. According to numerous follow-up studies after the midline suture, these increased significantly and could be observed in up to 74 % of patients. The healing disorders were mainly due to wound infections, which were hoped to be fought by placing antibiotic carriers inside the wound in the subcutaneous fatty tissue. However, the results of these measures were not very convincing.
Assuming problem-free wound healing, the midline suture leads to a shorter time out of work compared to open wound treatment. However, if the long-term results after excision of the fistula area with open wound treatment are compared with the incision including the midline suture, the suture technique shows a higher recurrence rate of fistula formation.
Comparing Limberg plastic and midline suture, Limberg plastic gives better long-term results with little-renewed fistula formation. In direct comparison, fewer wound healing disorders are also observed with Limberg plastic.
The excision of the fistula area with subsequent midline suture thus leads to significantly more wound healing disorders and renewed fistula formation, so that it cannot be recommended for the treatment of pilonidal cyst and tailbone fistula.
Literature sources:
Kooistra HP (1942) Pilonidal sinuses. Am J Surg 55:3–17
Gencosmanoglu R, Inceoglu R (2005) Modified lay-open (incision, curettage, partial lateral wall excision and marsupialization) versus total excision with primary closure in the treatment of chronic sacrococcygeal pilonidal sinus: a prospective, randomized clinical trial with a complete two-year follow-up. Int J Colorectal Dis 20:415–422
Holmebakk T, Nesbakken A (2005) Surgery for pilonidal disease. Scand J Surg 94:43–46
Abu Galala KH, Salam IM et al (1999) Treatment of pilonidal sinus by primary closure with a transposed rhomboid flap compared with deep suturing: a prospective randomised clinical trial. Eur J Surg 165:468–472
Baier PK, Baumgartner U et al (2002) Therapy of the pilonidal sinus-Primary wound closure or open wound after excision. Zentralbl Chir 127:310–314
Brieler HS (1997) Infected pilonidal sinus. Langenbecks Arch Chir Suppl Kongressbd 114:497– 500
Denkers D, Girona J (1996) Der abszedierte Sinus pilonidalis der Steißbeinregion -Möglichkeiten der chirurgischen Versorgung. Coloproctology 18:257–259
Doll D, Evers T et al (2011) Does gentamycin affect long term recurrence rate in pilonidal sinus surgery. Eur Surg 1–8
Dudink R, Veldkamp J et al (2011) Secondary healing versus midline closure and modified Bascom natal cleft lift for pilonidal sinus disease. Scand J Surg 100:110–113
Lee SL, Tejirian T et al (2008) Current management of adolescent pilonidal disease. J Pediatr Surg 43:1124–1127
Muzi MG, Milito G et al (2010) Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal disease. Am J Surg 200:9–14
Muzi MG, Milito G et al (2009) A modification of primary closure for the treatment of pilonidal disesae in day-care setting. Colorectal Dis 11:84–88
Nursal TZ, Ezer A et al (2010) Prospective randomized controlled trial comparing V-Y advancement flap with primary suture methods in pilonidal disease. Am J Surg 199:170–177
Sondenaa K, Anderson E et al (1992) Morbidity and short term results in a randomised trial of open compared with closed treatment of chronic pilonidal sinus. Eur J Surg 158:351–355
Tavassoli A, Noorshafiee S et al (2011) Comparison of excision with primary repair versus Limberg flap. Int J Surg 9:343–346
Vogel P, Lenz J (1992) Behandlung des Sinus pilonidalis durch Excision und Primärverschluß unter Verwendung eines lokalen, resorbierenden Antibiotikaträgers. Ergebnisse einer prospektiven randomizierten Studie. Chirurg 63:748–753
AlHassan HK, Francis IM et al (1990) Primary closure or secondary granulation after excision of pilonidal sinus? Acta Chir Scand 156:695–699
AlSalamah SM, Hussain MI et al (2007) Excision with or without primary closure for pilonidal sinus disease. J Pak Med Assoc 57:388–391
Kronborg O, Christensen K et al (1985) Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg 72:303–304
Lorant T, Ribbe I et al (2011) Sinus excision and primary closure versus laying open in pilonidal disease: a prospective randomized trial. Dis Colon Rectum 54:300–305
Akca T, Colak T et al (2005) Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of primary sacrococcygeal pilonidal disease. Br J Surg 92:1081–1084
