Finding the Perfect Spot: How Pits Location Shapes Surgical Choices in Chronic Sacrococcygeal Pilonidal Disease: Insights from a Specialized Center.

Document Type : Original Article

Authors

1 Colorectal Surgery Unit, General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt

2 General Surgery Department, Mansoura University Hospitals, Mansoura, Egypt

3 Gastrointestinal and Oncological Surgery Department, Klinikum Vest, Recklinghausen, Germany, University Witten Herdecke, Surgery Department II, Germany

Abstract

Introduction: SPND can present with varying symptoms, from asymptomatic cases to severe infections and
abscesses, or chronic inflammation with recurrent discharge.
Aim of work: Various surgical techniques exist for managing chronic sacrococcygeal pilonidal disease, but
standardization in choosing the appropriate procedure remains lacking. This study evaluates the choice of surgical
technique based on pit location.
Patients and methods: A comprehensive analysis of 107 patients was conducted at a tertiary center. Surgical
technique selection was informed by the surgeon’s assessment of pit characteristics (Size, number, and location).
Postoperative complications, one-year recurrence, and favourable outcomes were analysed.
Results: Preoperative findings revealed differences among flap-based techniques regarding recurrence, lateral
pit number, and pit distance from the midline. Postoperative outcomes varied significantly across techniques
concerning healing time, drain removal, resumption of daily activity, and complications like flap ischemia and
wound dehiscence. A 6.5% recurrence rate was observed, with 83.2% showing favourable outcomes. Delayed
healing predicted recurrence, while pit distance from the midline predicted better outcomes.
Conclusion: Patients with lateral pits up to 3 mm from the midline are suitable for primary closure. More lateral
pits (Up to 20 mm) warrant rhomboid flaps, and those up to 30 mm are better managed with rotational flaps.

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