Marsupialization after Undermining Excision and Flap-Like Margin Creation vs. (Marsupialization Only) or (Excision and Laying Open) Treatments for Pilonidal Sinus (PNS)


bAckground: Pilonidal disease treatment should be minimal, minimal pain, short hospitalization, low recurrence rate, minimal wound care, and allow rapid return to normal activity. Unfortunately, no treatment meets all these ideal goals.Aim: This study is conducted to find out a modality treatment for PNS that can achieve the above goals.Methodology: It is a retro and prospective study of 51 patients presented with PNS.All were divided randomly into 3 groups; First group treated by excision of the sinuses and laid the wound open. Second group treated by excision and marsupialization and third group treated by excision of skin containing sinuses’ openings only and further undermined (beneath the skin) resection of the infected tissues with flap forming with marsupialization of flap margins to the sacral fascia .Results: Healing time; Third group healed earlier.Post-operative painkillers; Third group needed less painkillers for shorter time.Return to daily activities; Third group return to their jobs and life activities earlier.Infection: Third group had only one case of cellulitis.Recurrent PNS; zero patient from third group had recurrent cellulitis.Discussion: Third group modality will reduce the tension on sutures and reduce the postoperative pain, and loosening sutures, also further reduces the recurrence rate.Conclusion: Third group modality yields a promising results in term of reducing the healing time, post-operative pain, recurrence of PNS and infection rates.It could be widely adopted, and would be largely cost-effective modality, as it will reduce the expenses of caring for wound, antibiotics use, painkiller use and the early return to the job.