Pankaj Garg, MBBS, MS, FASCRS1, Sachi Singhal, MBBS2, Sachin B Jamma, MBBS, MS3, Suresh Vasistha, MBBS, MS4. 1Garg Fistula Research Institute, Panchkula, India, India, 2Dayanand Medical College, Ludhiana, Punjab, India, 3Ashwini Rural Medical College, Kumbhari, Solapur, Maharashtra, India, 4Mangalam Hospital, Gurgaon, India
Purpose: Pilonidal sinus disease (PND)(including acute abscess) is very much similar to any subcutaneous abscess and should be treated like one. Logically also excision is unwarranted as PND is not a malignancy. Therefore, standard treatment of a routine abscess, simply laying open and curettage of sinus under local anesthesia(LOCULA), should suffice as adequate treatment for PND. We tested the efficacy of laying open and curettage of sinus under local anesthesia(LOCULA) procedure in all types of PND (simple and complicated).
Methods: All patients with chronic PND, recurrent disease and abscess were prospectively recruited between March 2011 and June 2018. Laying open with curettage of sinus cavity and its deroofing was done under local anesthesia on an outpatient basis. The wound was allowed to heal by secondary intention(Figure-1). The primary outcome measure was cure rate (recurrence). The secondary outcome measures were hospital stay, operating time, time taken to return to work, healing time and complication rate.
Results: Eighty-one(81) consecutive patients were prospectively recruited over a 7.5 years and were followed for 3-89 months(median- 26 months). One patient was lost to follow up. Mean age -23.4 ± 4.7 years and M/F – 65/15. 24/80(30%) presented as pilonidal abscess and 56/80(70%) as chronic pilonidal disease. 21/80(26%) had recurrent disease. The operating time was 21.0 ± 5.5 minutes and the hospital stay after the operation was 61.9 ± 21.5 minutes. The patients were able to resume their normal work in 3.8 ± 3.1 days and the healing time was 44.6± 8.3 days. 76/80(95%) patients had complete resolution of the disease and four(5%) had a recurrence. All the recurrences happened in the patients who didn’t adhere to the prescribed recommendations after the complete healing. Three patient with recurrence was operated again with the same procedure and got cured. The fourth patient was lost to follow up. Thus the overall cure rate was 98.75%. Two patient had a minor bleeding within the first week after the operation. Both the patients were managed conservatively in the outpatient clinic and the wound got healed subsequently.
Conclusions: LOCULA had cure rate & complication rate of 95% (overall- 98.75%) and 2.5%. respectively. The procedure is also much less morbid(done under local anesthesia, no admission required, resumption of normal work within hours and much smaller wound). Laying open(deroofing) and curettage under local anesthesia (LOCULA) as an outpatient procedure should be the first line procedure for all types of Pilonidal disease and abscess.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95210
Program Number: P331
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster