Research Article
Volume 8 Issue 1 - 2021
Use of Primary Closure on Tension-Free Midline for Treatment of Sacrococcygeal Pilonidal Disease: Experience and Results
Santiago de la Fuente1, Jhimy Terceros2, Daniela Castillo3 and Luis Carlos Ferrari4*
12nd Year Resident General Surgery, Sanatoria Aconcagua and Santo Tomás Private City of Córdoba, Argentina
23rd Year Resident General Surgery, Sanatoria Aconcagua and Santo Tomás Private City of Córdoba, Argentina
34th Year Resident General Surgery, Sanatoria Aconcagua and Santo Tomás Private City of Córdoba, Argentina
4Head of the Aconcagua and Santo Tomás Private Sanatorium Coloproctology Section of the City of Córdoba, Argentina
*Corresponding Author: Luis Carlos Ferrari, Head of the Aconcagua and Santo Tomás Private Sanatorium Coloproctology Section of the City of Córdoba, Argentina.
Received: October 07, 2020; Published: December 10, 2020


Background: Currently the surgical treatment for Sacrococcygeal pilonidal disease (SPD) is based on a wide resection of the lesion with or without its primary closure. Performing the latter over the primary midline suturing is simple and widely known, though with elevated dehiscence and relapsing infection. Primary closure far from the midline, as proposed by Karydakis or by the use of grafts like the Limberg technique, show better results. Although, when the primary closure is performed tension-free over the midline, results can be equivalent to those reached by these techniques, therefore it should be considered.

Aim: Prospectively assess the tension-free primary closure technique over the midline and their results in the treatment for SPD.

Design: Prospective observational study.

Method: 49 consecutive patients underwent SPD surgery between 01.10.2010 and 30.11.2019 by the same surgeon, where a tension-free primary closure was performed.

Results: 49 consecutive patients underwent surgery; mean age was 20,9 years old (between 14 and 37 years old) from which 69,38% (34 of 49) were men. Post-operative complications included, 1 patient showed bleeding (2, 04%); 16 patients partial opening of the primary closure (32,65%). Relapse occurred in 2 patients (4,08%) with 95,91% healing (47/49). Only 1 patient presented infection in the surgical wound (2,04%). Hospital stay was 1 day in all of the cases. Immediate post-operative intervention was not necessary. Healing time was 31,06 days (19 minimum/ 52 maximum). Pathological anatomy revealed non-malignant pilonidal cyst in all of the cases, with lesion-free resection in the margins. All patients expressed full conformity with the procedure.

Conclusion: The tension-free primary closure technique is a simple procedure, with brief hospital stay and with a low recurrence index or complications, reason why it should be considered when choosing a surgical technique in order to solve this pathology.

Keywords: Pilonidal Disease; Tension Free Closure


  1. Larsson JC., et al. Tratamiento de la enfermedad pilonidal crónica. Comparación de 3 técnicas quirúrgicas”. Revista Argentina de Coloproctología 2 (2014): 64-70.
  2. Muzi MG., et al. “Randomized comparison of Limberg flap versus modified primary closure for the treatment of pilonidal desease”. The American Journal of Surgery 200 (2010): 9-14.
  3. Guner A and Cekic AB. “Pilonidal sinus: challenges and solutions”. Open Access Surgery 8 (2015): 67-71.
  4. Chintapatla S., et al. “Sacrococcygeal pilonidal sinus: historical review, pathological insight and surgical opcions”. Techniques in Coloproctology 7 (2003): 3-8.
  5. Karydakis GE. “New approach to the problem of pilonidal sinus”. The Lancet 22 (1973): 1414-1415.
  6. Karydakis GE. “Easy and successful treatment of pilonidal sinus after explanation of its causative process”. Australia and New Zealand Journal Surgeon 62 (1992): 385-389.
  7. Akca T., et al. “Randomized clinical trial comparing primary closure with the Limberg flap in the treatment of sacrococcygeal pilonidal disease”. British Journal of Surgery 92 (2005): 1081-1084.
  8. Bannura G. “Cuál es el tratamiento quirúrgico de elección de la enfermedad pilonidal sacroccocígea?” Rev Chil Cir1 (2003): 92-96.
  9. Bannura G. “Enfermedad pilonidal sacroccocígea: factores de riesgo y tratamiento quirúrgico”. Rev Chil Cir5 (2011): 527-533.
  10. Youssef T., et al. “Tension-free primary closure compared with modified Limberg flap for pilonidal sinus disease: a prospective balanced randomized study”. The Egyptian Journal of Surgery 34 (2015): 85-89.
  11. Petersen S., et al. “Primary closure techniques in chronic pilonidal sinus”. Diseases of the Colon and Rectum 45 (2002): 1458-1467.
  12. Brasel KJ., et al. “Meta-analysis comparing healing by primary closure and open healing after surgery for pilonidal sinus”. Journal of the American College of Surgeons 3 (2010): 431-434.
  13. Horwood J., et al. “Primary closure or rhomboid excision and Limberg flap for the management of primary sacrococcygeal pilonidal disease? A meta-analysis of randomized controlled trials”. Colorectal Disease 14 (2011): 143-151.
  14. Kitchen PRB. “Pilonidal sinus: experience with Karydakis flap”. British Journal of Surgery 83 (1996): 1452-1455.
  15. Melkonian E., et al. “Resultados a corto y largo plazo con la técnica de Karydakis para la enfermedad pilonidal sacroccocígea”. Rev Chil Cir1 (2013): 25-29.
  16. Bannura G., et al. “Operación de Karydakis ambulatoria en el manejo de la enfermedad pilonidal sacrococcígea”. Rev Chil Cir3 (2009): 256-260.
  17. Daphan C., et al. “Limberg flap repair for pilonidal sinus disease”. Diseases of the Colon and Rectum 47 (2004): 233-237.
  18. Okus A., et al. “Comparison of Limberg flap and tension free primary closure during pilonidal sinus surgery”. World Journal of Surgery 36 (2012): 431-435.
  19. Mahdy T. “Surgical treatment of the pilonidal disease: Primary closure or flap reconstruction after excision”. Diseases of the Colon and Rectum 51 (2008): 1816-1822.
  20. Cihan A., et al. “Modified Limberg flap reconstruction compares favourably with primary repair for pilonidal sinus surgery”. ANZ Journal of Surgery 74 (2004): 238-242.
  21. Soll C., et al. “A novel approach for treatment of sacroccygeal pilonidal sinus: less is more”. The International Journal of Colorectal Disease 32 (2008): 177-180.
  22. Sakr M., et al. “Assessment of Karydakis technique as compared with midline closure for the management of chronical pilonidal sinus”. Journal of Pelvic Medicine and Surgery 12 (2006): 201-206.
  23. Sevinc B., et al. “Randomized prospective comparison of midline and off-midline closure techniques in pilonidal sinus surgery”. Surgery (2015): 1-6.
  24. Alarcón del Agua I., et al. “Degeneración maligna sobre quiste pilonidal”. Cirugia y Cirujanos 79 (2011): 374-378.
  25. Mendoza Cruz I., et al. “Tumor epidermoide moderadamente diferenciado asociado a quiste pilonidal”. Cirugia y Cirujanos 82 (2014): 87-92.
Citation: Luis Carlos Ferrari.,et al. “Use of Primary Closure on Tension-Free Midline for Treatment of Sacrococcygeal Pilonidal Disease: Experience and Results”. EC Gastroenterology and Digestive System 8.1 (2021): 16-24.

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